Figures of the dead: A decade of tuberculosis mortality registrations in South Africa

Loveday, Marian; Mzobe, Yoliswa Nokwazi.; Pillay, Yogan; Barron, Peter

doi:10.7196/samj.2019.v109i10.14073

Cited by 20 publications

(16 citation statements)

References 25 publications

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“…The most recent estimated incidence rate is approximately 615 per 100 000 per year; 58% of all people with TB are living with HIV [2]. While increased access to antiretroviral therapy (ART) has contributed to improved TB prevention and care, TB remains the leading cause of death in South Africa [3,4]. Tuberculosis case finding policy in most high-TB prevalence settings recommends routine symptom screening of all adult clinic attendees and testing those who self-present with TB symptoms (cough of any duration, night sweats, loss of weight, or fever) [5,6].…”

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confidence: 99%

Prevalence ofMycobacterium tuberculosisin Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa

Govender

Karat

Olivier

et al. 2021

Clinical Infectious Diseases

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Background Tuberculosis (TB) case finding efforts typically target symptomatic people attending health facilities. We compared the prevalence of Mycobacterium tuberculosis (Mtb) sputum culture-positivity among adult clinic attendees in rural South Africa with a concurrent, community-based estimate from the surrounding demographic surveillance area (DSA). Methods Clinic: Randomly-selected adults (≥18 years) attending two primary healthcare clinics were interviewed and requested to give sputum for mycobacterial culture. HIV and antiretroviral therapy (ART) status were based on self-report and record review. Community: All adult (≥15 years) DSA residents were invited to a mobile clinic for health screening, including serological HIV testing; those with ≥1 TB symptom (cough, weight loss, night sweats, fever) or abnormal chest radiograph were asked for sputum. Results Clinic: 2,055 patients were enrolled (76.9% female, median age 36 years); 1,479 (72.0%) were classified HIV-positive (98.9% on ART) and 131 (6.4%) reported ≥1 TB symptom. Of 20/2,055 (1.0% [95% CI 0.6–1.5]) with Mtb culture-positive sputum, 14 (70%) reported no symptoms. Community: 10,320 residents were enrolled (68.3% female, median age 38 years); 3,105 (30.3%) tested HIV-positive (87.4% on ART) and 1,091 (10.6%) reported ≥1 TB symptom. Of 58/10,320 (0.6% [95% CI 0.4–0.7]) with Mtb culture-positive sputum, 45 (77.6%) reported no symptoms. In both surveys, sputum culture positivity was associated with male sex and reporting >1 TB symptom. Conclusions In both clinic and community settings, most participants with Mtb culture-positive sputum were asymptomatic. TB screening based only on symptoms will miss many people with active disease in both settings.

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confidence: 99%

Prevalence ofMycobacterium tuberculosisin Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa

Govender

Karat

Olivier

et al. 2021

Clinical Infectious Diseases

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“…Older age has been associated with increased mortality from TB due to atypical presentations, increasing co-morbidities and more frequent drug related adverse events [18,19]. In our setting, older age has also been shown to be associated with decreased access to TB care services.…”

Section: Discussionmentioning

confidence: 72%

Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study

Kizito¹,

Musaazi

Mutesasira³

et al. 2021

BMC Infect Dis

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Background The World Health Organization (WHO) End TB strategy aims to reduce mortality due to tuberculosis (TB) to less than 5% by 2035. However, mortality due to multidrug-resistant tuberculosis (MDR-TB) remains particularly high. Globally, almost 20% of patients started on MDR-TB treatment die during the course of treatment every year. We set out to examine the risk factors for mortality among a cohort of patients diagnosed with MDR-TB in Uganda. Methods We conducted a case-control study nested within the national MDR-TB cohort. We defined cases as patients who died from any cause during the course of MDR-TB treatment. We selected two controls for each case from patients alive and on MDR-TB treatment at the time that the death occurred (incidence-density sampling). We matched the cases and controls on health facility at which they were receiving care. We performed conditional logistic regression to identify the risk factors for mortality. Results Data from 198 patients (66 cases and 132 controls) started on MDR-TB treatment from January 1 to December 31, 2016, was analyzed for this study. Cases were similar to controls in age/sex distribution, occupation and history of TB treatment. However, cases were more likely to be HIV infected while controls were more likely to have attained secondary level education. On multivariate regression analysis, co-infection with HIV (aOR 1.9, 95% CI [1.1–4.92] p = 0.05); non-adherence to MDR-TB treatment (aOR 1.92, 95% CI [1.02–4.83] p = 0.04); age over 50 years (aOR 3.04, 95% CI [1.13–8.20] p = 0.03); and having no education (aOR 3.61, 95% CI [1.1–10.4] p = 0.03) were associated with MDR-TB mortality. Conclusion To mitigate MDR-TB mortality, attention must be paid to provision of social support particularly for older persons on MDR-TB treatment. In addition, interventions that support treatment adherence and promote early detection and management of TB among HIV infected persons should also be emphasized.

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“…Ensuring that patients are screened for TB and started on TB treatment as soon as they present to the healthcare system (same-day diagnosis) may reduce pretreatment LFU and in turn improve outcomes among women diagnosed with TB. Increased mortality among older patients with TB has been reported in other studies [24,25] and may be caused by late diagnosis due to atypical presentations and presence of other co-morbidities. https://doi.org/10.1371/journal.pone.0241611.g003…”

Section: Plos Onementioning

confidence: 70%

Estimating the effect of pretreatment loss to follow up on TB associated mortality at public health facilities in Uganda

et al. 2020

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Introduction Tuberculosis (TB) mortality estimates derived only from cohorts of patients initiated on TB treatment do not consider outcomes of patients with pretreatment loss to follow-up (LFU). We aimed to assess the effect of pretreatment LFU on TB-associated mortality in the six months following TB diagnosis at public health facilities in Uganda. Methods At ten public health facilities, we retrospectively reviewed treatment data for all patients with a positive Xpert®MTB/RIF test result from January to June 2018. Pretreatment LFU was defined as not initiating TB treatment within two weeks of a positive test. We traced patients with pretreatment LFU to ascertain their vital status. We performed Kaplan Meier survival analysis to compare the cumulative incidence of mortality, six months after diagnosis among patients who did and did not experience pretreatment LFU. We also determined the health facility level estimates of TB associated mortality before and after incorporating deaths prior to treatment initiation among patients who experienced pretreatment LFU. Results Of 510 patients with positive test, 100 (19.6%) experienced pretreatment LFU. Of these, we ascertained the vital status of 49 patients. In the six months following TB diagnosis, mortality was higher among patients who experienced pretreatment LFU 48.1/1000py vs 22.9/1000py. Hazard ratio [HR] 3.18, 95% confidence interval [CI] (1.61–6.30). After incorporating deaths prior to treatment initation among patients who experienced pretreatment LFU, health facility level estimates of TB associated mortality increased from 8.4% (95% CI 6.1%-11.6%) to 10.2% (95% CI 7.7%-13.4%). Conclusion Patients with confirmed TB who experience pretreatment LFU have high mortality within the first six months. Efforts should be made to prioritise linkage to treatment for this group of patients. Deaths that occur prior to treatment initation should be included when reporting TB mortality in order to more accurately reflect the health impact of TB.

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Figures of the dead: A decade of tuberculosis mortality registrations in South Africa

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 20 publications

References 25 publications

Prevalence ofMycobacterium tuberculosisin Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa

Prevalence ofMycobacterium tuberculosisin Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa

Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study

Estimating the effect of pretreatment loss to follow up on TB associated mortality at public health facilities in Uganda

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