Time to death and associated factors among Tuberculosis patients in dangila woreda, Northwest ethiopia

Abstract

Background: Tuberculosis is among the leading cause of morbidity and mortality worldwide. According to World Health Organization 2013 report the estimated prevalence and incidence rate of TB in Ethiopia was 224 and 247 per 100,000 populations respectively. The mortality rate was 18 per 100,000 populations. Among patients who died during TB treatment more than 70% occurred in the first two months of anti-TB medication. HIV positive, old age and re-treatment cases were found to be the major risk factors that increase early death of TB patients. Objective: To assess the time of reported death and associated factors in a cohort of patients with tuberculosis during anti-tuberculosis treatment in Dangila Woreda, Northwest Ethiopia, 2008-2012. Methods: Institution based retrospective cohort study was conducted in March 2014. All TB patients registered in DOTs clinic from 2008-2012 were included in to the study. The collected data was checked for completeness, coded, and then entered into Epi data software then edited, cleaned and exported to SPSS for analysis. Descriptive statistics was used to determine frequency, percentage, mean and median. The survival probability of patients who were on TB treatment was analyzed by Kaplan Meier method and KM plot was applied to see the survival curve among different categories of TB patients. Cox regression analysis was applied to assess the association between the outcome and explanatory variables. Result: From a total of 872 cases registered on TB log book 810 were used for the analysis and 60(7.4%) died during TB treatment. The mean and median survival time was 7.6 and 7.7 months respectively. The overall incidence rate of death was 12.8 per 1000 person months of observation. Majority of TB deaths 34(56.7%) occurred during intensive phase and the median time of death for patients who died during TB treatment was 2 months. The comparison of Kaplan Meier survival curve and log rank test revealed that there was a significant difference between patient categories. Age, HIV status and baseline body weight were independent predictors of death during anti-TB treatment regimen. Conclusion: This study showed that most patients died in the first two months of TB treatment initiation. Risk factors like old age, TB/HIV co-infection and weight <35kg during treatment initiation were significantly associated with increased rate of death during TB treatment. Therefore, screening for TB every patient who visits the ART clinic and provision of prophylaxis as necessary is needed to reduce the effect of TB/HIV co-infection. Additional nutritional support especially for underweight patients is needed reduce death during TB treatment.