<p>Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study</p>

Abstract

Background: Visceral leishmaniasis (VL) is a neglected tropical disease, affecting the poor and productive age group of a country, resulting in a huge impact on its economic development. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, there is still death of these patients while on treatment. In this aspect, there are limited studies in Ethiopia; therefore, this study aimed to determine the incidence of mortality and its predictors among adult VL patients at the University of Gondar Hospital. Methods: Institution-based retrospective cohort study was conducted among 586 adult visceral leishmaniasis patients who were admitted to the University of Gondar Hospital from 2013 to 2018. Data were collected from the patients' charts and registration books, and analyzed using Stata 14 software. Kaplan-Meier failure curve and Log rank test was used to compare the survival probability of patients with independent variables. A multivariable stratified Cox regression model was used to identify predictors of mortality among VL patients. P≤ 0.05 was employed to declare statistically significant factors. Adjusted hazard ratio (AHR) and 95% confidence interval (95% CI) were estimated for potential risk factors included in the multivariable model. Results: A total of 586 VL patients were included in the study. The age of patients ranged from 18 to 55 years with a median age of 27 years. The incidence of mortality was 6.6 (95% CI: 5.2-8.4) per 1000 person-days of observation. Independent predictors of mortality were presence of comorbidity (AHR=2.29 (95% CI: 1.27-4.11)), relapse VL (AHR=3.03 (95% CI: 1.25-7.35)), treatment toxicity (AHR=5.87 (95% CI: 3.30-10.44)), nasal bleeding (AHR=2.58 (95% CI: 1.48-4.51)), jaundice (AHR=2.84 (95% CI: 1.57-5.16)) and being bedridden at admission (AHR=3.26 (95% CI: 1.86-5.73)). Conclusion: The incidence of mortality among VL patients was high. Mortality was higher among VL patients with concomitant disease, relapse VL, treatment toxicity, nasal bleeding, jaundice, and those who were bedridden at admission, which implies that great care should be taken for these risky groups through strict follow-up and treatments.

Hematological and Clinical Features Associated with Initial Poor Treatment Outcomes in Visceral Leishmaniasis Patients with and without HIV Coinfection in Gondar, Northwest Ethiopia

“…The overall mortality rate among all VL patients at the time of admission to the hospital was 5.1%, which is comparable to reports from Gondar, Ethiopia (4.8%) [ 46 ] and Brazil (7.0%) [ 47 ]. Of note, higher case fatality rates (11% to 18%) than our finding were reported in previous studies from Ethiopia [ 26 , 48 , 49 ], yet reports from South Sudan (2.8%) [ 50 ] and Uganda (3.7%) [ 51 ] showed lower case fatality rates. The variation in the mortality rates among studies might be partly attributed to the differences in HIV coinfection rates, duration of illness, presence of comorbidities, change in the treatment modalities, and the sample size.…”

Epidemiological, Serological, and Entomological Investigation of New Visceral Leishmaniasis Foci in Nepal

“…Although we do not know the causes of death, comorbidity, relapse VL, and treatment toxicity could be the reasons for poor VL treatment outcomes. 16 Therefore, follow-up of treated VL cases is very important.…”

Aetiologies of acute undifferentiated febrile illness at the emergency ward of the University of Gondar Hospital, Ethiopia

“…Although we included tests for the commonly known circulating pathogens, the aetiology of AFI remained undetermined in 79.5% of the patients. Yet, diseases like visceral leishmaniasis, brucellosis, leptospirosis and acute schistosomiasis, which occur in Ethiopia [61][62][63][64], were not tested for in this study. Overall, the large number of unidentified aetiologies indicates the need for implementation of a broader diagnostic platform such as metagenomics [65][66][67] to increase the knowledge on the circulating pathogens causing AFI, which can be used to improve patient care.…”