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Observational Study
. 2016 May 20:16:214.
doi: 10.1186/s12879-016-1534-y.

Poor tuberculosis treatment outcomes in Southern Mozambique (2011-2012)

Alberto L García-Basteiro  1   2   3 , Durval Respeito  4 , Orvalho J Augusto  4 , Elisa López-Varela  4   5 , Charfudin Sacoor  4 , Victor G Sequera  5 , Aina Casellas  5 , Quique Bassat  4   5 , Ivan Manhiça  6 , Eusebio Macete  5 , Frank Cobelens  7 , Pedro L Alonso  4   5
Affiliations
Observational Study

Poor tuberculosis treatment outcomes in Southern Mozambique (2011-2012)

Alberto L García-Basteiro et al. BMC Infect Dis. .

Erratum in

Abstract

Background: In Mozambique, there is limited data regarding the monitoring of Tuberculosis (TB) treatment results and determinants of adverse outcomes under routine surveillance conditions. The objectives of this study were to evaluate treatment outcomes among TB patients, analyze factors associated with a fatal outcome and determine the proportion of deaths attributable to TB in the district of Manhiça, Southern Mozambique.

Methods: This is a retrospective observational study based on TB patients diagnosed in the period 2011-2012. We used three different data sources: a) TB related variables collected by the National TB Control Program in the district of Manhiça for all TB cases starting treatment in the period 2011-2012. b) Population estimates for the district were obtained through the Mozambican National Statistics Institute. c) Deaths and other relevant demographic variables were collected from the Health and Demographic Surveillance System at Manhiça Health Research Center. WHO guidelines were used to define TB cases and treatment outcomes.

Results: Of the 1957 cases starting TB treatment in the period 2011-2012, 294 patients (15.1 %) died during anti-tuberculous treatment. Ten per cent of patients defaulted treatment. The proportion of patients considered to have treatment failure was 1.1 %. HIV infection (OR 2.73; 95 % CI: 1.70-4.38), being male (OR: 1.39; 95 % CI 1.01-1.91) and lack of laboratory confirmation (OR: 1.54; 95 % CI 1.12-2.13) were associated with dying during the course of TB treatment (p value <0.05). The contribution of TB to the overall death burden of the district for natural reasons was 6.5 % (95 % CI: 5.5-7.6), higher for males than for females (7.8 %; 95 % CI: 6.1-9.5 versus 5.4 %; 95 % CI: 4.1-6.8 respectively). The age group within which TB was responsible for the highest proportion of deaths was 30-34 among males and 20-24 among females (20 % of all deaths in both cases).

Conclusion: This study shows a very high proportion of fatal outcomes among TB cases starting treatment. There is a high contribution of TB to the overall causes of mortality. These results call for action in order to improve TB (and TB/HIV) management and thus treatment outcomes of TB patients.

Keywords: Adverse outcome; Death; Manhiça; Mortality; Tuberculosis.

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Figures

Fig. 1
Fig. 1
TB incidence rate in the district of Manhiça by sex and age group (year 2011)
Fig. 2
Fig. 2
Kaplan-Meier survival estimates by a) HIV status b) ARV treatment c) Type of TB d) Laboratory confirmation (year 2011–2012)
See this image and copyright information in PMC

References

    1. World Health Organization . Global Tuberculosis Report 2014. Geneva, Switzerland: World Health Organization; 2014.
    1. García-Basteiro AL, López-Varela E, Manhiça I, Macete E, Alonso PL. Mozambique faces challenges in the fight against tuberculosis. Lancet. 2014;383:215–6. doi: 10.1016/S0140-6736(14)60069-6. - DOI - PubMed
    1. Plano Estrategico Nacional de Controlo da Tuberculose em Moçambique para o periodo 2008–2012. http://www.who.int/countries/moz/publications/tb_national_strategy.pdf Accessed 15 May 2016.
    1. Saifodine A, Gudo PS, Sidat M, Black J. Patient and health system delay among patients with pulmonary tuberculosis in Beira city, Mozambique. BMC Public Health. 2013;13:559. doi: 10.1186/1471-2458-13-559. - DOI - PMC - PubMed
    1. The Global Plan to Stop TB (2011–2015). http://stoptb.org/assets/documents/global/plan/TB_GlobalPlanToStopTB2011... Accessed 13 May 2016.

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