Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana

Burton, Nicole; Forson, Audrey; Lurie, Mark N.; Kudzawu, Samuel; Kwarteng, Ernest; Kwara, Awewura

doi:10.1016/j.trstmh.2011.07.017

Cited by 35 publications

(33 citation statements)

References 28 publications

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“…Nevertheless, retreatment outcomes were complicated by a considerable number of patients with death, default, or treatment failure as manifested by persistent sputum smear positivity. Similar to other cohorts from subSaharan Africa, HIV infection remained the strongest predictor of poor outcome, 7 and patients with the lowest CD4 count on admission frequently suffered from early inpatient death.…”

supporting

confidence: 66%

The Influence of Mining and Human Immunodeficiency Virus Infection Among Patients Admitted for Retreatment of Tuberculosis in Northern Tanzania

Mpagama¹,

Lekule²,

Mbuya³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. In tuberculosis (TB)-prevalent settings, patients admitted for retreatment of TB may account for a high burden of poor treatment outcome. We performed a retrospective cohort study to characterize retreatment patients and outcomes at a TB referral hospital in northern Tanzania. From 2009 to 2013, 185 patients began a retreatment regimen, the majority for relapse after prior treatment completion. Men accounted for an unexpected majority (88%), 36 (20%) were human immunodeficiency virus (HIV) infected and for 45 (24%) mining was their primary occupation. A poor outcome (death, default, or persistent smear positivity after 7 months of treatment) was found in 37 (23%). HIV infection was the only significant predictor of poor outcome (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI] = 1.07-5.83, P = 0.034). Interventions to minimize need for retreatment or improve retreatment success may be regionally specific. In our setting, community-based diagnosis and management among at-risk subpopulations such as miners and those HIV infected appear of highest yield.In Tanzania, like many tuberculosis (TB) endemic countries, patients categorized as undergoing retreatment for TB account for proportionally the highest rates of death, treatment failure, and default among all TB patients excluding those with known drug resistance.1 The national estimate for treatment success rate in human immunodeficiency virus (HIV)-negative patients without prior treatment was 90%, but was 80% in patients with a history of TB treatment.1 Patients undergoing retreatment are often prescribed the World Health Organization (WHO) Category II regimen of extended total duration, which contains the daily intramuscular injection of streptomycin, a medication with considerable cumulative side effects including ototoxicity and vestibular toxicity that may further compromise treatment completion. Kibong'oto Infectious Diseases Hospital (KIDH) is a regional referral hospital for retreatment TB cases, and the national referral hospital for multidrug-resistant (MDR) TB. The Mererani region includes numerous small-scale mining operations, principally involved in the mining of the precious gemstone tanzanite. The mines are run with low-level mechanization, use roughly 8,000 transient workers, and are situated in a community of approximately 200,000 people with interdependence on the mining industry.3 The mining occupation in other TB-endemic settings has been associated with high rates of HIV coinfection, comorbid lung disease such as silicosis and risk of TB reinfection.4 Perception suggests that miners account for a considerable number of patients admitted to KIDH for retreatment and may account for a greater proportion of those with poor retreatment outcome.We therefore sought to perform a retrospective cohort study of all patients admitted to KIDH for a retreatment regimen over the past 5 years to define the local burden of retreatment, clinical characteristics among retreatment patients, and predictors of retreatment outcome.The hospi...

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supporting

confidence: 66%

The Influence of Mining and Human Immunodeficiency Virus Infection Among Patients Admitted for Retreatment of Tuberculosis in Northern Tanzania

Mpagama¹,

Lekule²,

Mbuya³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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“…4,21,27 In our cohort, patients with these severe forms of EPTB were more likely to have HIV coinfection. HIV coinfection likely increased the risk of severe disease and death because of immunosuppression and delay in starting ART.…”

Section: Discussionmentioning

confidence: 72%

Factors associated with mortality in extrapulmonary tuberculosis patients at a teaching hospital in Ghana

Nassikas¹,

Yang²,

Forson³

et al. 2016

Ghana Medical Journal

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SUMMARYObjectives: To investigate the clinical manifestations and factors associated with mortality in patients with extrapulmonary tuberculosis (EPTB) at the Korle-Bu Teaching Hospital Chest Clinic in Accra, Ghana. Design: We conducted a retrospective chart review of patients treated for EPTB at the Chest Clinic between January 1, 2009 and December 31, 2011. Patients with a new diagnosis of EPTB without concomitant pulmonary disease, aged 18 years or older, and who were treated at the Chest Clinic were eligible for participation in the study. Relevant data were abstracted from medical records and entered into a database. The factors associated with mortality were examined using bivariate and multivariate analysis. Results: Of the 157 patients in the study, the most affected age group was 25-34 years old (33.1%), 57.3% were male, and 71 (55.5%) of the 128 patients tested for HIV were sero-positive. Overall, 62 (39.5%) died during EPTB treatment. Mortality was associated with disseminated TB (AOR 149.85; P < 0.001), TB meningitis (AOR 79.14; P < 0.001), abdominal TB (AOR 23.59; P = 0.011), pleural effusion (AOR 12.6; P = 0.021) and age (AOR 1.05; P = 0.021). Among HIV co-infected patients, early initiation of ART reduced mortality rate. Conclusions: The site of EPTB was a key determinant of mortality. Given that death occurs soon after diagnosis, patients with suspected TB meningitis, disseminated, abdominal and pleural TB should be targeted for early diagnosis and treatment to reduce the high EPTB mortality in our setting.

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“…The reasons for these are widely distributed. While immunocompromised conditions [3, 4], disseminated disease [5], and environmental factors such as poor living and work conditions [6] are considered significant parameters, undernourishment [7] and anaemic [8] status, constant exposure to infected individuals, and disruption in treatment [9, 10] are also implicated.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in Tuberculosis Related Mortalities in Hospitalized Patients

Haque

Kumar

Saifuddin

et al. 2014

Tuberculosis Research and Treatment

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Setting. The study was undertaken at the Department of Pulmonology at a public, tertiary care centre in Karachi, Pakistan. Objectives. To evaluate factors concerned with in-hospital deaths in patients admitted with pulmonary tuberculosis (TB). Design. A retrospective case-control audit was performed for 120 patients hospitalised with pulmonary TB. Sixty of those discharged after treatment were compared to sixty who did not survive. Radiological findings, clinical indicators, and laboratory values were compared between the two groups to identify factors related to poor prognosis. Results. Factors concerned with in-hospital mortality listed late presentation of disease (P < 0.01), noncompliance to antituberculosis therapy (P < 0.01), smoking (P < 0.01), longer duration of illness prior to treatment (P < 0.01), and low body weight (P < 0.01). Most deaths occurred during the first week of admission (P < 0.01) indicating late referrals as significant. Immunocompromised status and multi-drug resistance were not implicated in higher mortality. Conclusions. Poor prognosis was associated with noncompliance to therapy resulting in longer duration of illness, late patient referrals to care centres, and development of complications. Early diagnosis, timely referrals, and monitored compliance may help reduce mortality. Adherence to a more radically effective treatment regimen is required to eliminate TB early during disease onset.

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Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana

Cited by 35 publications

References 28 publications

The Influence of Mining and Human Immunodeficiency Virus Infection Among Patients Admitted for Retreatment of Tuberculosis in Northern Tanzania

The Influence of Mining and Human Immunodeficiency Virus Infection Among Patients Admitted for Retreatment of Tuberculosis in Northern Tanzania

Factors associated with mortality in extrapulmonary tuberculosis patients at a teaching hospital in Ghana

Prognostic Factors in Tuberculosis Related Mortalities in Hospitalized Patients

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