Abstract
Background: Tuberculosis is a leading cause of death globally, and the third leading cause of death in Zimbabwe. Death from any cause following a diag-nosis of tuberculosis is classified as a tuberculosis death. Bulawayo Province reported high tuberculosis death rates from 15.3% in 2016 to 14.2% in 2019 against a threshold of 5%. We analyzed tuberculosis deaths for Bulawayo Province to characterize patients dying and to make recommendations for im-proving treatment outcomes for susceptible tuberculosis cases. Methods: A descriptive cross-sectional study was conducted. We analyzed all (N = 469) records of tuberculosis deaths from 19/19 Bulawayo tuberculosis diagnosing centers from 01 January 2016 to 31 December 2019. Microsoft® Excel 2007 was used to generate graphs and Stata® version 17 was used to conduct chi-square tests for trends. Results: Males accounted for 278/469 (59.3%) of the deaths. The median age of death was 40 years (Q1 = 33: Q3 = 51). The proportion of TB deaths increased from 63/114 (55%) in 2016 to 57/90 (63%) in 2019 for males (p < 0.01). The majority of deaths 278/469 (59.3%) occurred in the intensive phase of treatment and anemia was a co-morbid condition in only 44/469 (9.4%) of the tuberculosis deaths. Testing for anemia was not rou-tinely done. Conclusion: High death rates particularly in the intensive phase, could be attributed to sub-optimal clinical care. Tuberculosis programs should work towards adopting differentiated care models for tuberculosis patients and developing algorithms for patients at high risk of death.
Highlights
Death from any cause in a person who had a diagnosis of tuberculosis (TB) is classified as a tuberculosis death [1]
Trends and Distribution of TB Deaths Demographic characteristics of TB patients who died Males accounted for 278/469 (59.3%) of the deaths
In this study, which was conducted in a low-income country, the major findings were that: there was a significant increase in the proportion of tuberculosis deaths among males, and for patients in the intensive phase of treatment, the majority of the deaths occurred among males, Human Immunodeficiency Virus (HIV) co-infected patients, and among patients in the intensive phase of treatment, and the availability of tests for co-morbid conditions like anemia, and renal failure was affected by the shortages of reagents
Summary
Death from any cause in a person who had a diagnosis of tuberculosis (TB) is classified as a tuberculosis death [1]. Tuberculosis is a preventable communicable disease and ranks amongst the top ten causes of death globally [2]. Death during TB treatment is not merely a function of infection with Mycobacterium tuberculosis but there are host, disease, and health system factors that contribute to the negative outcome [1]. Bulawayo Province reported high tuberculosis death rates from 15.3% in 2016 to 14.2% in 2019 against a threshold of 5%. We analyzed tuberculosis deaths for Bulawayo Province to characterize patients dying and to make recommendations for improving treatment outcomes for susceptible tuberculosis cases. The majority of deaths 278/469 (59.3%) occurred in the intensive phase of treatment and anemia was a co-morbid condition in only 44/469 (9.4%) of the tuberculosis deaths. Tuberculosis programs should work towards adopting differentiated care models for tuberculosis patients and developing algorithms for patients at high risk of death
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