Abstract
BackgroundRecently, the tuberculosis (TB) Task Force Impact Measurement acknowledged the need to review the assumptions underlying the TB mortality estimates published annually by the World Health Organization (WHO). TB mortality is indirectly measured by multiplying estimated TB incidence with estimated case fatality ratio (CFR). We conducted a meta-analysis to estimate the TB case fatality ratio in TB patients having initiated TB treatment.MethodsWe searched for eligible studies in the PubMed and Embase databases through March 4th 2011 and by reference listing of relevant review articles. Main analyses included the estimation of the pooled percentages of: a) TB patients dying due to TB after having initiated TB treatment and b) TB patients dying during TB treatment. Pooled percentages were estimated using random effects regression models on the combined patient population from all studies.Main ResultsWe identified 69 relevant studies of which 22 provided data on mortality due to TB and 59 provided data on mortality during TB treatment. Among HIV infected persons the pooled percentage of TB patients dying due to TB was 9.2% (95% Confidence Interval (CI): 3.7%–14.7%) and among HIV uninfected persons 3.0% (95% CI: −1.2%–7.4%) based on the results of eight and three studies respectively providing data for this analyses. The pooled percentage of TB patients dying during TB treatment was 18.8% (95% CI: 14.8%–22.8%) among HIV infected patients and 3.5% (95% CI: 2.0%–4.92%) among HIV uninfected patients based on the results of 27 and 19 studies respectively.ConclusionThe results of the literature review are useful in generating prior distributions of CFR in countries with vital registration systems and have contributed towards revised estimates of TB mortality This literature review did not provide us with all data needed for a valid estimation of TB CFR in TB patients initiating TB treatment.
Highlights
Each year, the World Health Organization (WHO) publishes country-specific estimates of tuberculosis (TB) incidence, TB prevalence and TB mortality [1]
The TB case fatality ratio (CFR) estimates used by WHO and reported in several publications and journals [3,5,6,7] were based on literature searches assessing mortality during TB treatment; risk of TB relapse and late complications; autopsy series for the cause of death in patients with TB according to human immunodeficiency virus (HIV) status, smear status and treatment regimen
For example: we found that smear negative TB patients infected with HIV seemed to have a higher CFR (38%; 95% confidence interval (CI): 23%–53%) than smear positive TB patients infected with HIV (19%; 95% CI: 15%–23%)
Summary
The World Health Organization (WHO) publishes country-specific estimates of tuberculosis (TB) incidence, TB prevalence and TB mortality [1]. In countries without adequate data from national vital registration systems, TB deaths are indirectly estimated by multiplying estimated TB incidence with an estimate of the case-fatality ratio (CFR), accounting for uncertainty in incidence and CFR [2]. Such indirect TB mortality estimates heavily depend on the reliability of underlying estimates of incidence and CFR [3]. TB mortality is indirectly measured by multiplying estimated TB incidence with estimated case fatality ratio (CFR). We conducted a meta-analysis to estimate the TB case fatality ratio in TB patients having initiated TB treatment
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
