Deaths during tuberculosis treatment among paediatric patients in a large tertiary hospital in Nigeria

Abstract

BackgroundDespite availability of effective cure, tuberculosis (TB) remains a leading cause of death in children. In many high-burden countries, childhood TB is underdiagnosed and underreported, and care is often accessed too late, resulting in adverse treatment outcomes. In this study, we examined the time to death and its associated factors among a cohort of children that commenced TB treatment in a large treatment centre in northern Nigeria.MethodsThis is a retrospective cohort study of children that started TB treatment between 2010 and 2014. We determined mortality rates per 100 person-months of treatment, as well as across treatment and calendar periods. We used Cox proportional hazards regression to determine adjusted hazard ratios (aHR) for factors associated with mortality.ResultsAmong 299 children with a median age 4 years and HIV prevalence of 33.4%; 85 (28.4%) died after 1,383 months of follow-up. Overall mortality rate was 6.1 per 100 person-months. Deaths occurred early during treatment and declined from 42.4 per 100 person-months in the 1st week of treatment to 2.2 per 100 person-months after at the 3rd month of treatment. Mortality was highest between October to December period (9.1 per 100 pm) and lowest between July and September (2.8 per 100 pm). Risk factors for mortality included previous TB treatment (aHR 2.04:95%CI;1.09–3.84); HIV infection (aHR 1.66:95%CI;1.02–2.71), having either extra-pulmonary disease (aHR 2.21:95%CI;1.26–3.89) or both pulmonary and extrapulmonary disease (aHR 3.03:95%CI;1.70–5.40).ConclusionsMortality was high and occurred early during treatment in this cohort, likely indicative of poor access to prompt TB diagnosis and treatment. A redoubling of efforts at improving universal health coverage are required to achieve the End TB Strategy target of zero deaths from TB.

Outcome of Childhood Tuberculosis at a Specialist Hospital in Gusau, Nigeria

“…The mortality rate seen in this study was low, which is similar to 3.5% reported from Ethiopia [15] but higher than 1.1% reported from India [12,13]. It is however lower than 6.0% reported from Lagos [14] and 28.4% from Kano [20]. The reason for the differences could be due to difference in methodology (some studies were retrospective others prospective, sample size); timing of presentation; presence of complications and other associated medical problems.…”

Tuberculosis Treatment Outcome and Predictors in Africa: A Systematic Review and Meta-Analysis

“…Over half of the articles (61.5%) used cohort study design [7,9,13,14,[25][26][27][28][29][30][31][32][33][34][35][36] whereas the rest 38.8% were retrospective cross-sectional studies [10,[37][38][39][40][41][42][43][44] (Table 1). A total of 306,351 study participants with a sample size ranging from 227 in Ethiopia [41] to 170,017 in South Africa [37]; for studies conducted in Ethiopia and South Africa respectively.…”

“…A total of 306,351 study participants with a sample size ranging from 227 in Ethiopia [41] to 170,017 in South Africa [37]; for studies conducted in Ethiopia and South Africa respectively. Most of the study populations were from regions that are currently listed under the WHO as high TB burden countries [7,9,10,13,14,[26][27][28][29][30]32,33,[36][37][38][39][40][41][42][43][44][45].…”

“…Out of the total 319,224 participants included from the original studies, 260,407 (85.0%) of them had a successful TB treatment outcome; which is the sum of cured and completed cases. The TB treatment success rate varied from the lowest 157/299 (52.5%) reported in Nigeria [28], to the highest prevalence rate 914/995 (91.9%) reported from Ethiopia [39]. In some of the studies, some participants were on treatment and it is known that the treatment outcome for those who were transferred out did not yet confirm.…”

Factors associated with death in patients with tuberculosis in Brazil: Competing risks analysis

“…Several studies have suggested that factors associated with survival in cases of TB are related to the presence of specific comorbidities, including HIV/AIDS and diabetes mellitus [3][4][5][6][7][8][9]; some clinical characteristics, such as drug resistance, default of treatment, extrapulmonary and mixed forms [3,6,10,11]; specific sociodemographic characteristics of patients (age, male gender, schooling, color or race, etc); and lifestyle, such as alcoholism and smoking [4,7,11,12]. In Brazil, few studies of survival analysis after TB treatment were identified in the literature [7,13].…”