Factors associated with death among TB patients in Tanzania in 2017

Abstract

Abstract Background: Tuberculosis (TB) is the main cause of death from a sole infectious agent worldwide. Tanzania is among the 30 high burden countries with a mortality of 47 per 100,000 population and a case fatality of 4%. Although there are many studies conducted on TB mortality rate and risk factors using routine data from other countries, inconsistent findings from various studies prompted further studies to be conducted to assess whether factors reported in previous studies are applicable in our local setting. Objectives: This study intended to determine the mortality rate, survival probabilities, and factors associated with death among TB patients. Methodology: A retrospective cohort study was conducted utilizing national TB program data of all TB cases registered from January 2017 to December 2017. Kaplan-Meier estimator was used to determine survival probabilities and an extended Cox proportional model was used to identify independent risk factors of death among TB patients. Hazard ratios and 95% confidence intervals are presented. Results: Among 61,979 patients, 2114 (3.4%) patients died during TB treatment giving a mortality rate of 6.0 per 1000 person-months. The independent risk factors for death among TB patients included older age ≥60 years (aHR = 2.51, 95% CI = 2.11-2.99), accessing service at the hospital level (aHR = 1.15, 95% CI = 1.04-1.27), TB/HIV Co-infection (aHR = 2.89, 95% CI = 2.61- 3.20), and facility-based DOT option (aHR = 2.25, 95% CI = 1.83 - 2.79). Other factors were sputum negative results (aHR =1.37, 95% CI = 1.21-1.58), having extrapulmonary TB (aHR =1.21, 95% CI = 1.08-1.34), being referred from other sources (aHR =1.48, 95% CI = 1.22- 1.80), residing in southern highland zone (aHR =1.73, 95% CI = 1.38- 2.18), Southern Zone (aHR =1.57, 95% CI = 1.22-2.01) and western zone (aHR =1.54, 95% CI = 1.21-1.97). Conclusion: We identified several independent predictors of death among TB patients among different risk groups. To achieve the milestone of reducing TB mortality by 2035, it is critical to formulate appropriately targeted interventions on the prompt detection, diagnosis, and appropriate referral of TB patients among the risk groups