Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province

J Christo Heunis,N Gladys Kigozi,Perpetual Chikobvu,HCJ Dingie van Rensburg,Sonja Botha

doi:10.1186/s12889-016-3972-2

J Christo Heunis, N Gladys Kigozi + Show 3 more

Open Access

https://doi.org/10.1186/s12889-016-3972-2

Copy DOI

Abstract

BackgroundSince 1990, reduction of tuberculosis (TB) mortality has been lower in South Africa than in other high-burden countries in Africa. This research investigated the influence of routinely captured demographic and clinical or programme variables on death in TB patients in the Free State Province.MethodsA retrospective review of case information captured in the Electronic TB register (ETR.net) over the years 2003 to 2012 was conducted. Extracted data were subjected to descriptive and logistic regression analyses. The outcome variable was defined as all registered TB cases with ‘died’ as the recorded outcome. The variables associated with increased or decreased odds of dying in TB patients were established. The univariate and adjusted odds ratios (OR and AOR) together with their corresponding 95% confidence intervals (CI) were estimated, taking the clustering effect of the districts into account.ResultsOf the 190,472 TB cases included in the analysis, 30,991 (16.3%) had ‘died’ as the recorded treatment outcome. The proportion of TB patients that died increased from 15.1% in 2003 to 17.8% in 2009, before declining to 15.4% in 2012. The odds of dying was incrementally higher in the older age groups: 8–17 years (AOR: 2.0; CI: 1.5–2.7), 18–49 years (AOR: 5.8; CI: 4.0–8.4), 50–64 years (AOR: 7.7; CI: 4.6–12.7), and ≥65 years (AOR: 14.4; CI: 10.3–20.2). Other factors associated with increased odds of mortality included: HIV co-infection (males – AOR: 2.4; CI: 2.1–2.8; females – AOR: 1.9; CI: 1.7–2.1) or unknown HIV status (males – AOR: 2.8; CI: 2.5–3.1; females – AOR: 2.4; CI: 2.2–2.6), having a negative (AOR: 1.4; CI: 1.3–1.6) or a missing (AOR: 2.1; CI: 1.4–3.2) pre-treatment sputum smear result, and being a retreatment case (AOR: 1.3; CI: 1.2–1.4).ConclusionsAlthough mortality in TB patients in the Free State has been falling since 2009, it remained high at more than 15% in 2012. Appropriately targeted treatment and care for the identified high-risk groups could be considered.

Highlights

Since 1990, reduction of tuberculosis (TB) mortality has been lower in South Africa than in other high-burden countries in Africa
Mortality among TB patients increased from 15.1% in 2003 to 17.8% in 2009 before declining to 15.4% in 2012 (Fig. 2)
Gender was not independently associated with mortality (OR: 1.0; confidence intervals (CI): 0.9–1.2), after adjusting for other variables in the model, the risk of dying among males was significantly lower compared to females (AOR: 0.8; CI: 0.7–0.9)

Summary

Introduction

Since 1990, reduction of tuberculosis (TB) mortality has been lower in South Africa than in other high-burden countries in Africa. Numbers of deaths and concomitant mortality rates represent traditional measures of the burden and impact of diseases and the state of public health [1]. While South Africa has made notable progress in reducing TB prevalence and deaths and improving treatment outcomes for new smear-positive TB cases [5], overall reduction of TB mortality of only 6% over the years 1990 to 2013 is substandard considering that over the same period TB deaths declined by 45% globally and 40% in the African region [6]. The World Health Organization’s (WHO) ‘End TB Strategy’ has set the target to reduce TB deaths by 95% by the year 2035. In order to reach this target, the proportion of people with

Methods

Results

Discussion

Conclusion