High mortality among TB patients on treatment in Nigeria: a retrospective cohort study
Abstract
Background
Tuberculosis (TB) remains
a leading cause of death in much of sub-Saharan Africa despite
available effective treatment. Prompt initiation of TB treatment
and access to antiretroviral therapy (ART) remains vital to the
success of TB control. We assessed time to mortality after
treatment onset using data from a large treatment centre in
Nigeria.
Methods
We analysed a retrospective
cohort of TB patients that commenced treatment between January
2010 and December 2014 in Aminu Kano Teaching Hospital. We
estimated mortality rates per person-months at risk (pm). Cox
proportional hazards model was used to determine risk factors
for mortality.
Results
Among 1,424 patients with a
median age of 36.6 years, 237 patients (16.6%) died after
commencing TB treatment giving a mortality rate of 3.68 per 100
pm of treatment in this cohort. Most deaths occurred soon after
treatment onset with a mortality rate of 37.6 per 100 pm in the
1st week of treatment. Risk factors for death were being
HIV-positive but not on anti-retroviral treatment (ART) (aHR
1.39(1 · 04–1 · 85)),
residence outside the city (aHR
3 · 18(2.28–4.45)), previous TB
treatment (aHR 3.48(2.54–4.77)), no microbiological
confirmation (aHR 4.96(2.69–9.17)), having both pulmonary
and extra-pulmonary TB (aHR 1.45(1.03–2.02), and referral
from a non-programme linked clinic/centre (aHR
3.02(2.01–4.53)).
Conclusions
We attribute early
deaths in this relatively young cohort to delay in diagnosis and
treatment of TB, inadequate treatment of drug-resistant TB, and
poor ART access. Considerable expansion and improvement in
quality of diagnosis and treatment services for TB and HIV are
needed to achieve the sustainable development goal of reducing
TB deaths by 95% by 2035.
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Source:
BMC Infectious Diseases
