Cargando…

High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study

BACKGROUND: Tuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment. Prompt initiation of TB treatment and access to antiretroviral therapy (ART) remains vital to the success of TB control. We assessed time to mortality after treatment o...

Descripción completa

Detalles Bibliográficos
Autores principales: Adamu, Aishatu L., Gadanya, Muktar A., Abubakar, Isa S., Jibo, Abubakar M., Bello, Musa M., Gajida, Auwalu U., Babashani, Musa M., Abubakar, Ibrahim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324260/
https://www.ncbi.nlm.nih.gov/pubmed/28231851
http://dx.doi.org/10.1186/s12879-017-2249-4
_version_ 1782510189832830976
author Adamu, Aishatu L.
Gadanya, Muktar A.
Abubakar, Isa S.
Jibo, Abubakar M.
Bello, Musa M.
Gajida, Auwalu U.
Babashani, Musa M.
Abubakar, Ibrahim
author_facet Adamu, Aishatu L.
Gadanya, Muktar A.
Abubakar, Isa S.
Jibo, Abubakar M.
Bello, Musa M.
Gajida, Auwalu U.
Babashani, Musa M.
Abubakar, Ibrahim
author_sort Adamu, Aishatu L.
collection PubMed
description BACKGROUND: Tuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment. Prompt initiation of TB treatment and access to antiretroviral therapy (ART) remains vital to the success of TB control. We assessed time to mortality after treatment onset using data from a large treatment centre in Nigeria. METHODS: We analysed a retrospective cohort of TB patients that commenced treatment between January 2010 and December 2014 in Aminu Kano Teaching Hospital. We estimated mortality rates per person-months at risk (pm). Cox proportional hazards model was used to determine risk factors for mortality. RESULTS: Among 1,424 patients with a median age of 36.6 years, 237 patients (16.6%) died after commencing TB treatment giving a mortality rate of 3.68 per 100 pm of treatment in this cohort. Most deaths occurred soon after treatment onset with a mortality rate of 37.6 per 100 pm in the 1(st) week of treatment. Risk factors for death were being HIV-positive but not on anti-retroviral treatment (ART) (aHR 1.39(1 · 04–1 · 85)), residence outside the city (aHR 3 · 18(2.28–4.45)), previous TB treatment (aHR 3.48(2.54–4.77)), no microbiological confirmation (aHR 4.96(2.69–9.17)), having both pulmonary and extra-pulmonary TB (aHR 1.45(1.03–2.02), and referral from a non-programme linked clinic/centre (aHR 3.02(2.01–4.53)). CONCLUSIONS: We attribute early deaths in this relatively young cohort to delay in diagnosis and treatment of TB, inadequate treatment of drug-resistant TB, and poor ART access. Considerable expansion and improvement in quality of diagnosis and treatment services for TB and HIV are needed to achieve the sustainable development goal of reducing TB deaths by 95% by 2035.
format Online
Article
Text
id pubmed-5324260
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-53242602017-03-01 High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study Adamu, Aishatu L. Gadanya, Muktar A. Abubakar, Isa S. Jibo, Abubakar M. Bello, Musa M. Gajida, Auwalu U. Babashani, Musa M. Abubakar, Ibrahim BMC Infect Dis Research Article BACKGROUND: Tuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment. Prompt initiation of TB treatment and access to antiretroviral therapy (ART) remains vital to the success of TB control. We assessed time to mortality after treatment onset using data from a large treatment centre in Nigeria. METHODS: We analysed a retrospective cohort of TB patients that commenced treatment between January 2010 and December 2014 in Aminu Kano Teaching Hospital. We estimated mortality rates per person-months at risk (pm). Cox proportional hazards model was used to determine risk factors for mortality. RESULTS: Among 1,424 patients with a median age of 36.6 years, 237 patients (16.6%) died after commencing TB treatment giving a mortality rate of 3.68 per 100 pm of treatment in this cohort. Most deaths occurred soon after treatment onset with a mortality rate of 37.6 per 100 pm in the 1(st) week of treatment. Risk factors for death were being HIV-positive but not on anti-retroviral treatment (ART) (aHR 1.39(1 · 04–1 · 85)), residence outside the city (aHR 3 · 18(2.28–4.45)), previous TB treatment (aHR 3.48(2.54–4.77)), no microbiological confirmation (aHR 4.96(2.69–9.17)), having both pulmonary and extra-pulmonary TB (aHR 1.45(1.03–2.02), and referral from a non-programme linked clinic/centre (aHR 3.02(2.01–4.53)). CONCLUSIONS: We attribute early deaths in this relatively young cohort to delay in diagnosis and treatment of TB, inadequate treatment of drug-resistant TB, and poor ART access. Considerable expansion and improvement in quality of diagnosis and treatment services for TB and HIV are needed to achieve the sustainable development goal of reducing TB deaths by 95% by 2035. BioMed Central 2017-02-23 /pmc/articles/PMC5324260/ /pubmed/28231851 http://dx.doi.org/10.1186/s12879-017-2249-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Adamu, Aishatu L.
Gadanya, Muktar A.
Abubakar, Isa S.
Jibo, Abubakar M.
Bello, Musa M.
Gajida, Auwalu U.
Babashani, Musa M.
Abubakar, Ibrahim
High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study
title High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study
title_full High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study
title_fullStr High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study
title_full_unstemmed High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study
title_short High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study
title_sort high mortality among tuberculosis patients on treatment in nigeria: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324260/
https://www.ncbi.nlm.nih.gov/pubmed/28231851
http://dx.doi.org/10.1186/s12879-017-2249-4
work_keys_str_mv AT adamuaishatul highmortalityamongtuberculosispatientsontreatmentinnigeriaaretrospectivecohortstudy
AT gadanyamuktara highmortalityamongtuberculosispatientsontreatmentinnigeriaaretrospectivecohortstudy
AT abubakarisas highmortalityamongtuberculosispatientsontreatmentinnigeriaaretrospectivecohortstudy
AT jiboabubakarm highmortalityamongtuberculosispatientsontreatmentinnigeriaaretrospectivecohortstudy
AT bellomusam highmortalityamongtuberculosispatientsontreatmentinnigeriaaretrospectivecohortstudy
AT gajidaauwaluu highmortalityamongtuberculosispatientsontreatmentinnigeriaaretrospectivecohortstudy
AT babashanimusam highmortalityamongtuberculosispatientsontreatmentinnigeriaaretrospectivecohortstudy
AT abubakaribrahim highmortalityamongtuberculosispatientsontreatmentinnigeriaaretrospectivecohortstudy