Poor tuberculosis treatment outcomes in Southern Mozambique (2011–2012)

Alberto L García-Basteiro,Orvalho J Augusto,Charfudin Sacoor,Ivan Manhiça,Frank Cobelens,Quique Bassat,Aina Casellas,Victor G Sequera,Eusebio Macete,Elisa López-Varela,Pedro L Alonso,Durval Respeito

doi:10.1186/s12879-016-1534-y

Abstract

BackgroundIn Mozambique, there is limited data regarding the monitoring of Tuberculosis (TB) treatment results and determinants of adverse outcomes under routine surveillance conditions. The objectives of this study were to evaluate treatment outcomes among TB patients, analyze factors associated with a fatal outcome and determine the proportion of deaths attributable to TB in the district of Manhiça, Southern Mozambique.MethodsThis is a retrospective observational study based on TB patients diagnosed in the period 2011–2012. We used three different data sources: a) TB related variables collected by the National TB Control Program in the district of Manhiça for all TB cases starting treatment in the period 2011–2012. b) Population estimates for the district were obtained through the Mozambican National Statistics Institute. c) Deaths and other relevant demographic variables were collected from the Health and Demographic Surveillance System at Manhiça Health Research Center. WHO guidelines were used to define TB cases and treatment outcomes.ResultsOf the 1957 cases starting TB treatment in the period 2011–2012, 294 patients (15.1 %) died during anti-tuberculous treatment. Ten per cent of patients defaulted treatment. The proportion of patients considered to have treatment failure was 1.1 %. HIV infection (OR 2.73; 95 % CI: 1.70–4.38), being female (OR: 1.39; 95 % CI: 1.31–1.91) and lack of laboratory confirmation (OR 1.51; 95 % CI: 1.10–2.08) were associated with dying during the course of TB treatment (p value <0.05). The contribution of TB to the overall death burden of the district for natural reasons was 6.5 % (95 % CI: 5.5–7.6), higher for males than for females (7.8 %; 95 % CI: 6.1–9.5 versus 5.4 %; 95 % CI: 4.1–6.8 respectively). The age group within which TB was responsible for the highest proportion of deaths was 30–34 among males and 20–24 among females (20 % of all deaths in both cases).ConclusionThis study shows a very high proportion of fatal outcomes among TB cases starting treatment. There is a high contribution of TB to the overall causes of mortality. These results call for action in order to improve TB (and TB/HIV) management and thus treatment outcomes of TB patients.

Highlights

In Mozambique, there is limited data regarding the monitoring of Tuberculosis (TB) treatment results and determinants of adverse outcomes under routine surveillance conditions
The main objective of this study was to evaluate the treatment outcomes among TB patients and analyze factors associated with a fatal outcome
Thirty-three per cent of all TB cases were confirmed by smear microscopy (45.6 % and 2.2 % for pulmonary and extrapulmonary TB respectively)

Summary

Introduction

In Mozambique, there is limited data regarding the monitoring of Tuberculosis (TB) treatment results and determinants of adverse outcomes under routine surveillance conditions. The objectives of this study were to evaluate treatment outcomes among TB patients, analyze factors associated with a fatal outcome and determine the proportion of deaths attributable to TB in the district of Manhiça, Southern Mozambique. Tuberculosis (TB) remains an important public health concern and a leading cause of disease and death worldwide. According to the last global TB report it accounts for 9 million new cases and 1.5 million deaths per year [1]. Most of these deaths occur in Sub-Saharan Africa. The HIV epidemic, which has stricken the country deeply, hinders the millennium development goal of halting and beginning to reverse the incidence of TB by 2015 at a country level; a goal achieved by most countries in the world.

Objectives

Methods

Results

Discussion

Conclusion