Time to Death and Associated Factors among Tuberculosis Patients in Dangila Woreda, Northwest Ethiopia

Abayneh Birlie,Tariku Dejene,Kifle Woldemichael,Getnet Tesfaw,Philip C Hill

doi:10.1371/journal.pone.0144244

Abayneh Birlie, Tariku Dejene + Show 3 more

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https://doi.org/10.1371/journal.pone.0144244

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Abstract

BackgroundTuberculosis (TB) is among the leading causes of morbidity and mortality worldwide. More than 70% of the deaths of TB patients occur during the first two months of TB treatment. The major risk factors that increase early death of TB patients are being positive for human immunodeficiency virus (HIV), being of old age, being underweight or undergoing re-treatment.ObjectiveTo assess the time of reported deaths and associated factors in a cohort of patients with TB during TB treatment.MethodsAn institution-based retrospective cohort study was analyzed in Dangila Woreda, Northwest Ethiopia from March 1st through March 30, 2014. All TB patients registered in the direct observed treatment (DOTs) clinic from 2008–2012 were included in the study. Data were entered into EpiData and exported to SPSS for analysis. The survival probability was analyzed by the Kaplan Meier method and Cox regression analysis was applied to investigate factors associated with death during TB treatment.ResultsFrom a total of 872 cases registered in TB registry log book, 810 were used for the analysis of which 60 (7.4%) died during the treatment. The overall mortality rate was 12.8/1000 person months of observation. A majority of TB deaths 34 (56.7%) occurred during the intensive phase of the treatment, and the median time of death was at two months of the treatment. Age, HIV status and baseline body weight were independent predictors of death during TB treatment.ConclusionsMost deaths occurred in the first two months of TB treatment. Old age, TB/HIV co-infection and a baseline body weight of <35 kg increased the mortality during TB treatment. Therefore, a special follow up of TB patients during the intensive phase, of older patients and of TB/HIV co-infected cases, as well as nutritionally supplementing for underweight patients may be important to consider as interventions to reduce deaths during TB treatment.

Highlights

Tuberculosis is a chronic mycobacterial infection present in all parts of the world [1]
TB/human immunodeficiency virus (HIV) co-infection and a baseline body weight of
A special follow up of TB patients during the intensive phase, of older patients and of TB/HIV co-infected cases, as well as nutritionally supplementing for underweight patients may be important to consider as interventions to reduce deaths during TB treatment

Summary

Introduction

Tuberculosis is a chronic mycobacterial infection present in all parts of the world [1]. About a third of the world’s population are estimated to be infected with M. tuberculosis, albeit mostly without clinical symptoms. These silent carriers bear a life time risk of developing active disease [2, 3, 4], with more than 95% of cases and deaths occurring in the developing world [4, 5]. TB kills nearly 2 million persons per year worldwide It is still one of the leading causes of death in the world accounting for 2.5% of the global burden of diseases and 25% of all avoidabledeaths-in-developing-countries-[1]. The major risk factors that increase early death of TB patients are being positive for human immunodeficiency virus (HIV), being of old age, being underweight or undergoing retreatment.

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