Predictors of mortality among multidrug resistance tuberculosis patients admitted at Kibong’oto hospital from 2009-2016.

Abstract

Background:Treatment of Multi Drug Resistant-Tuberculosis (MDR-TB) in many patients represents the last opportunity for cure. In spite of significant investments to improve availability of chemotherapy and effective treatment options, still a significant proportion of patients die during the course of their treatment. Understanding the factors leading to early death following diagnosis and treatment of MDR-TB is important for TB programmesto improve the way they identify and manage patients and help to guide targeted interventions to improve overall survival. Objective: To estimate mortality rate and determine predictors of mortality among MDR-TB patients admitted at Kibong’oto hospital, Tanzania. Methodology:A retrospective cohort study was done at Kibong’oto hospital among all patients diagnosed and admitted with MDR-TB between 2009 and 2016. Individual and clinical information was abstracted from patient medical records, In-depth interviews werealso done to supplement quantitative data. Incidence of mortality was calculated using Kaplan Meier method and Cox regression was modeled to identify predictors of deathduring MDR-TB treatment adjusting for potential confounders. Hazard ratios and their 95% confidence intervals are presented. Significant level was set at α = 5%. Results:A total of 583 patients were recruited with a mean age of 37.41(standard deviation = 13.62). 68.1% were men, 77.47% had a previous TB history,59.06% reported experiencing a drug adverse effect and 37.43% had other co-morbidities mainly HIV (35.49%) and anemia (9.21%).The mortality rate was 15.3%.After adjusting for other factors, mortality in MDR TB patients was significantly associated with nutrition (HR =2.90; 95%CI: 1.26-6.69) and anemia (HR = 3.03; 95% CI: 1.60-5.73). Conclusion: In spite of improvements in provision of care and treatment for MDR-TB, a modest rate in deaths still occurs that can be explained by poor nutritional status. Monitoring co-morbid conditions like anemia and malnutritionis important to increase survival amongstMDR-TB patients. There is a need to strengthen nutrition units in health facilities offering TB services in the country. Keywords: Mortality, Predictors, Multidrug ResistanceTuberculosis, MDR TB, Tanzania.