Mortality among persons receiving tuberculosis treatment in Itezhi-Tezhi District of Zambia: A retrospective cohort study

Abstract

Itezhi-Tezhi District in southern Zambia has been reporting tuberculosis (TB) mortality rates that are fourfold higher than the national average of six percent. We conducted a retrospective cohort study to establish the demographic and clinical characteristics associated with mortality among persons under treatment for TB in Itezhi-Tezhi District, as well as the likely causes and time to death. We reviewed medical records for persons with TB registered in 19 public health facilities in Itezhi-Tezhi District between January 2015 and December 2018. Of the 506 persons with TB registered in the study period, 426 were included in the analysis. Of these, 71 (16.7%) died before completing treatment. The overall mortality rate was 31.8 per 1,000 person-months of observation. Most of the deaths (53 [74.7%]) occurred in the first month of treatment (median: 16 days; interquartile range: 5–52 days). In a multivariate Cox regression model, type of TB was found to be an independent predictor of mortality while on TB treatment. The risk of dying was more than twice higher for persons with clinically diagnosed PTB compared to those with bacteriologically confirmed PTB (adjusted hazard ratio = 2.2, 95% CI: 1.4–3.6). In a sub-analysis of persons with clinically diagnosed PTB, persons with TB who were on a community-based DOT plan were more than twice more likely to die compared to those on facility-based DOT plan (adjusted hazard ratio = 2.21, 95% CI: 1.1–4.8). Common likely causes of death were pulmonary TB disease (66.0%), anemia (12.8%), cardiac failure (4.3%), pneumocystis jiroveci pneumonia (4.3%), and gastroenteritis (4.2%). These findings show that most deaths occurred during the first month of treatment. Clinical evaluation at initiation of anti-TB treatment and during follow-up care, especially in persons with clinically diagnosed PTB, should include screening and treatment of other conditions.

Treatment Outcomes and Associated Factors among Tuberculosis Patients from Selected Rural Eastern Cape Hospitals: An Ambidirectional Study

“…There was no record of a treatment default in this study. The mortality rate (9.9%) in this study is comparable to that found in the study in Jos Nigeria [ 36 ] but lower than that reported in Zimbabwe, 26.4% [ 30 ]; Sierra Leone, 20.5% [ 38 ]; Uganda, 18.4% [ 43 ]; and Zambia, 16.7% [ 50 ]. The disparity in treatment outcomes between these studies may be due to differences in the study population’s age, gender, and disease severity, the existence of comorbid conditions, tobacco use, the drug resistance pattern, social determinants of health, and socioeconomic characteristics [ 51 ].…”

Mortality among persons with tuberculosis in Zambian hospitals: A retrospective cohort study

“…Although Zambia is among the high-burden countries in Southern Africa that have recorded an impressive reduction in TB mortality rate from 228 per 100,000 populations in 2000 to 86 per 100,000 populations in 2020, this rate remains high [ 1 , 3 ]. Further, the TB program conducted an epidemiological review of their routine programme data in 2020 which revealed that since 2013, the mortality rate for all forms of TB has been oscillating around 6%, ranging from 3.3% for Lusaka Province, the country’s largest and capital city, to as high as 13.6% for Southern Province [ 4 ].…”

“…Factors associated with increased odds of mortality among people with TB include age of 65 years and above, being retreated for TB, being HIV-positive, having unknown HIV status, clinical diagnosis, and extra-pulmonary TB (EPTB) [ 3 , 7 , 13 ]. Mortality has also been found to be higher among persons with EPTB, women and undernourished persons [ 10 ].…”

“…A more convenient method of establishing causes of death among persons with TB is a review of medical records, including death certificates [ 3 , 17 , 19 ]. Using this method Lin et al found that the majority (82.7%) of persons in their study died from underlying comorbidities such as malignancy, liver cirrhosis, bacterial pneumonia, renal failure, and septic shock [ 17 ].…”

“…Using this method Lin et al found that the majority (82.7%) of persons in their study died from underlying comorbidities such as malignancy, liver cirrhosis, bacterial pneumonia, renal failure, and septic shock [ 17 ]. Cardiovascular diseases have also been found to be among the common causes of death among persons with TB [ 3 , 19 ].…”