Profile and Treatment Outcomes of Tuberculosis in the Elderly in Southeastern Nigeria, 2011–2012

Abstract

BackgroundThe demographic transition and increasing life expectancy in Africa has lead to a rising elderly population. In Nigeria, little is known about the profile of and treatment outcomes of tuberculosis (TB) in the elderly.MethodsRetrospective cohort study of adult TB patients treated between January 2011 and December 2012 in two large health facilities in Nigeria. The demographic, clinical and treatment outcomes of patients aged 60 and older were compared with those aged 15 to 59 years.ResultsElderly (≥60 years) TB patients accounted for 12.7% of all (1668) adult TB enrolled. Elderly patients had a higher proportion of men compared to non-elderly (64.2% vs 56.8%; p = 0.043); but a lower proportion of smear-positive TB at baseline (40.7% vs 65.8%; p<0.001). A higher proportion of elderly patients failed to smear convert after the intensive phase of treatment (23.7% vs 19.8%; p = 0.06), and overall elderly patients had lower treatment success rates (68.9% vs 77.1%; p = 0.009). Unsuccessful outcomes were mainly due to higher default and deaths in the elderly. The risk factors for unsuccessful outcomes in the elderly were: extrapulmonary TB case (adjusted odds ratio (aOR) 10.9; 95% confidence interval (CI) 1.1–108), and HIV co-infection (aOR 3.6; CI 1.1–11.7).ConclusionsTreatment outcomes of elderly TB patients were inferior to non-elderly adults with higher death and default rates being implicated. With the rising elderly population, specific strategies are needed to quickly address TB management in the elderly in resource-limited settings.

Treatment outcomes of new smear positive pulmonary tuberculosis patients under directly observed treatment in Anambra state, Nigeria

“…In this regard, a higher proportion of unsuccessful treatment outcome was seen in patients older than 65 years. This is in agreement with those of other studies [19,25,26]. The higher rate of unsuccessful treatment outcome observed among elderly patients may be due to multi-morbidity of pulmonary tuberculosis with diabetes mellitus and cardiovascular diseases.…”

“…But slightly lower than the new International target of 90% set for the period 2015-2035 by the WHO [6]. The treatment success rate in our study was however higher than the rate obtained in other parts of Nigeria: 78.5% in Abuja 77.1% in Ebonyi state [18,19]. Our finding was similar to 84.4% at Debre Berham Hospital Ethiopia [20].…”

Clinical outcomes and mortality associated factors in patients infected with HIV receiving a presumptive anti-tuberculosis treatment in a tertiary level hospital in Burkina Faso

“…TB is probably over-diagnosed because of the lack of means for proper diagnosis. Furthermore, several studies attribute the high mortality rates in SPNTB and EPTB to long delay of initiation of presumptive anti-TB treatment (Colebunders & Bastian, 2000;Oshi, Oshi, Alobu, & Ukwaja, 2014). The 41.4% mortality rate in PLHIV with SNPTB or EPTB in our study is close to the 46% mortality rate found in Malaysia (Ismail & Bulgiba, 2013) and 37.1% in Nigeria (Oshi et al, 2014).…”

Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable?

“…Although TB is among the 10 main causes of death among children worldwide, 9 childhood TB remains neglected in resource-limited settings TB treatment among the elderly (defined as persons aged 60 years in this study), has been found to be complicated by the treatment of comorbidities such as diabetes mellitus (DM), leading to increased adverse drug effects, mortality, high rates of recurrent TB and drug resistance. [10][11][12] This population, which also has high rates of HIV co-infection in Zimbabwe, may have distinctly different TB treatment outcomes from other age groups.…”