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Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study

BACKGROUND: The World Health Organization (WHO) End TB strategy aims to reduce mortality due to tuberculosis (TB) to less than 5% by 2035. However, mortality due to multidrug-resistant tuberculosis (MDR-TB) remains particularly high. Globally, almost 20% of patients started on MDR-TB treatment die d...

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Autores principales: Kizito, Enock, Musaazi, Joseph, Mutesasira, Kenneth, Twinomugisha, Fred, Namwanje, Helen, Kiyemba, Timothy, Freitas Lopez, Debora B., Nicholas, Nicholas Sebuliba, Nkolo, Abel, Birabwa, Estella, Dejene, Seyoum, Zawedde-Muyanja, Stella
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986038/
https://www.ncbi.nlm.nih.gov/pubmed/33752637
http://dx.doi.org/10.1186/s12879-021-05967-2
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author Kizito, Enock
Musaazi, Joseph
Mutesasira, Kenneth
Twinomugisha, Fred
Namwanje, Helen
Kiyemba, Timothy
Freitas Lopez, Debora B.
Nicholas, Nicholas Sebuliba
Nkolo, Abel
Birabwa, Estella
Dejene, Seyoum
Zawedde-Muyanja, Stella
author_facet Kizito, Enock
Musaazi, Joseph
Mutesasira, Kenneth
Twinomugisha, Fred
Namwanje, Helen
Kiyemba, Timothy
Freitas Lopez, Debora B.
Nicholas, Nicholas Sebuliba
Nkolo, Abel
Birabwa, Estella
Dejene, Seyoum
Zawedde-Muyanja, Stella
author_sort Kizito, Enock
collection PubMed
description BACKGROUND: The World Health Organization (WHO) End TB strategy aims to reduce mortality due to tuberculosis (TB) to less than 5% by 2035. However, mortality due to multidrug-resistant tuberculosis (MDR-TB) remains particularly high. Globally, almost 20% of patients started on MDR-TB treatment die during the course of treatment every year. We set out to examine the risk factors for mortality among a cohort of patients diagnosed with MDR-TB in Uganda. METHODS: We conducted a case-control study nested within the national MDR-TB cohort. We defined cases as patients who died from any cause during the course of MDR-TB treatment. We selected two controls for each case from patients alive and on MDR-TB treatment at the time that the death occurred (incidence-density sampling). We matched the cases and controls on health facility at which they were receiving care. We performed conditional logistic regression to identify the risk factors for mortality. RESULTS: Data from 198 patients (66 cases and 132 controls) started on MDR-TB treatment from January 1 to December 31, 2016, was analyzed for this study. Cases were similar to controls in age/sex distribution, occupation and history of TB treatment. However, cases were more likely to be HIV infected while controls were more likely to have attained secondary level education. On multivariate regression analysis, co-infection with HIV (aOR 1.9, 95% CI [1.1–4.92] p = 0.05); non-adherence to MDR-TB treatment (aOR 1.92, 95% CI [1.02–4.83] p = 0.04); age over 50 years (aOR 3.04, 95% CI [1.13–8.20] p = 0.03); and having no education (aOR 3.61, 95% CI [1.1–10.4] p = 0.03) were associated with MDR-TB mortality. CONCLUSION: To mitigate MDR-TB mortality, attention must be paid to provision of social support particularly for older persons on MDR-TB treatment. In addition, interventions that support treatment adherence and promote early detection and management of TB among HIV infected persons should also be emphasized.
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spelling pubmed-79860382021-03-24 Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study Kizito, Enock Musaazi, Joseph Mutesasira, Kenneth Twinomugisha, Fred Namwanje, Helen Kiyemba, Timothy Freitas Lopez, Debora B. Nicholas, Nicholas Sebuliba Nkolo, Abel Birabwa, Estella Dejene, Seyoum Zawedde-Muyanja, Stella BMC Infect Dis Research Article BACKGROUND: The World Health Organization (WHO) End TB strategy aims to reduce mortality due to tuberculosis (TB) to less than 5% by 2035. However, mortality due to multidrug-resistant tuberculosis (MDR-TB) remains particularly high. Globally, almost 20% of patients started on MDR-TB treatment die during the course of treatment every year. We set out to examine the risk factors for mortality among a cohort of patients diagnosed with MDR-TB in Uganda. METHODS: We conducted a case-control study nested within the national MDR-TB cohort. We defined cases as patients who died from any cause during the course of MDR-TB treatment. We selected two controls for each case from patients alive and on MDR-TB treatment at the time that the death occurred (incidence-density sampling). We matched the cases and controls on health facility at which they were receiving care. We performed conditional logistic regression to identify the risk factors for mortality. RESULTS: Data from 198 patients (66 cases and 132 controls) started on MDR-TB treatment from January 1 to December 31, 2016, was analyzed for this study. Cases were similar to controls in age/sex distribution, occupation and history of TB treatment. However, cases were more likely to be HIV infected while controls were more likely to have attained secondary level education. On multivariate regression analysis, co-infection with HIV (aOR 1.9, 95% CI [1.1–4.92] p = 0.05); non-adherence to MDR-TB treatment (aOR 1.92, 95% CI [1.02–4.83] p = 0.04); age over 50 years (aOR 3.04, 95% CI [1.13–8.20] p = 0.03); and having no education (aOR 3.61, 95% CI [1.1–10.4] p = 0.03) were associated with MDR-TB mortality. CONCLUSION: To mitigate MDR-TB mortality, attention must be paid to provision of social support particularly for older persons on MDR-TB treatment. In addition, interventions that support treatment adherence and promote early detection and management of TB among HIV infected persons should also be emphasized. BioMed Central 2021-03-22 /pmc/articles/PMC7986038/ /pubmed/33752637 http://dx.doi.org/10.1186/s12879-021-05967-2 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data.
spellingShingle Research Article
Kizito, Enock
Musaazi, Joseph
Mutesasira, Kenneth
Twinomugisha, Fred
Namwanje, Helen
Kiyemba, Timothy
Freitas Lopez, Debora B.
Nicholas, Nicholas Sebuliba
Nkolo, Abel
Birabwa, Estella
Dejene, Seyoum
Zawedde-Muyanja, Stella
Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study
title Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study
title_full Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study
title_fullStr Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study
title_full_unstemmed Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study
title_short Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study
title_sort risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in uganda- a case-control study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986038/
https://www.ncbi.nlm.nih.gov/pubmed/33752637
http://dx.doi.org/10.1186/s12879-021-05967-2
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