Abstract
BackgroundIndia has 2.0 million estimated tuberculosis (TB) cases per annum with an estimated 280,000 TB-related deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India:- i) treatment outcomes including the number who died while on treatment, ii) the month of death and iii) characteristics associated with "early" death, occurring in the initial 8 weeks of treatment.MethodsThis was a retrospective study in 16 selected Designated Microscopy Centres (DMCs) in Hyderabad, Krishna and Adilabad districts of Andhra Pradesh, South India. A review was performed of treatment cards and medical records of all TB patients (adults and children) registered and placed on standardized anti-tuberculosis treatment from January 2005 to September 2009.ResultsThere were 8,240 TB patients (5183 males) of whom 492 (6%) were known to have died during treatment. Case-fatality was higher in those previously treated (12%) and lower in those with extra-pulmonary TB (2%). There was an even distribution of deaths during anti-tuberculosis treatment, with 28% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with "early death".ConclusionIn this large cohort of TB patients, deaths occurred with an even frequency throughout anti-TB treatment. Reasons may relate to i) the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii) co-morbidities, such as HIV/AIDS and diabetes mellitus, which are known to influence mortality. More research in this area from prospective and retrospective studies is needed.
Highlights
India has 2.0 million estimated tuberculosis (TB) cases per annum with an estimated 280,000 TBrelated deaths per year
The aim of this study was to document the timing of reported death in a large cohort of patients with tuberculosis who die during treatment
We did not document the types of extra-pulmonary TB (EPTB) during this study, the majority of patients in India with EPTB have lymph node disease [13], which tends to be associated with morbidity but not mortality
Summary
India has 2.0 million estimated tuberculosis (TB) cases per annum with an estimated 280,000 TBrelated deaths per year. National TB Control Programmes (NTPs) routinely report treatment outcomes for patients with tuberculosis (TB). In sub-Saharan Africa, studies have shown that the majority of deaths occur early during the first 1-2 months of anti-tuberculosis treatment [1,2,3]. In sub-Saharan Africa, where coinfection with HIV is high, this information has been important for NTPs to plan realistic strategies to reduce death rates during treatment. Giving antiretroviral therapy (ART) during the initial phase rather than the continuation phase of anti-tuberculosis treatment is more beneficial in reducing death rates in coinfected TB patients, and is based on a sound knowledge of when HIV-infected TB patients die [4,5]. Similar reports of early deaths have come from more industrialised countries such as Singapore [6], Russia [7] and Taiwan [8]
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