Abstract
BackgroundTuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment. Prompt initiation of TB treatment and access to antiretroviral therapy (ART) remains vital to the success of TB control. We assessed time to mortality after treatment onset using data from a large treatment centre in Nigeria.MethodsWe analysed a retrospective cohort of TB patients that commenced treatment between January 2010 and December 2014 in Aminu Kano Teaching Hospital. We estimated mortality rates per person-months at risk (pm). Cox proportional hazards model was used to determine risk factors for mortality.ResultsAmong 1,424 patients with a median age of 36.6 years, 237 patients (16.6%) died after commencing TB treatment giving a mortality rate of 3.68 per 100 pm of treatment in this cohort. Most deaths occurred soon after treatment onset with a mortality rate of 37.6 per 100 pm in the 1st week of treatment. Risk factors for death were being HIV-positive but not on anti-retroviral treatment (ART) (aHR 1.39(1 · 04–1 · 85)), residence outside the city (aHR 3 · 18(2.28–4.45)), previous TB treatment (aHR 3.48(2.54–4.77)), no microbiological confirmation (aHR 4.96(2.69–9.17)), having both pulmonary and extra-pulmonary TB (aHR 1.45(1.03–2.02), and referral from a non-programme linked clinic/centre (aHR 3.02(2.01–4.53)).ConclusionsWe attribute early deaths in this relatively young cohort to delay in diagnosis and treatment of TB, inadequate treatment of drug-resistant TB, and poor ART access. Considerable expansion and improvement in quality of diagnosis and treatment services for TB and HIV are needed to achieve the sustainable development goal of reducing TB deaths by 95% by 2035.
Highlights
Tuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment
Aminu Kano Teaching Hospital (AKTH), is a large federal government run university hospital, established in 1988, which caters for populations from Kano and neighbouring states
Patients enrolled in the Directly observed treatment short-course (DOTS) service come from a variety of sources and include suspected and confirmed TB cases, referred from other clinics within the hospital and other hospitals including private health facilities
Summary
Tuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment. Despite effective treatment being available for over half a century, tuberculosis (TB) remains a leading cause of death worldwide [1, 2]. An estimated 1 · 5 million individuals died of TB in 2014, disproportionately affecting countries in sub-Saharan Africa and South-East Asia [5]. Contributory factors include HIV infection (0.4 million deaths), increasing levels of Recent evidence suggests that TB prevalence and mortality have been under-estimated in many high-burden countries with revised estimates from Nigeria changing global figures in 2013 [9]. The most populous country in Africa, has an estimated population of over 170 million people. Among the identified 22 high burden countries, Nigeria had the highest death rates in HIV-negative people in 2014 (97 per 100,000) and a high
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