Determinants of mortality among patients with drug-resistant tuberculosis in northern Nigeria


Autoři: Mamman Bajehson aff001;  Baba Maiyaki Musa aff002;  Mustapha Gidado aff003;  Bassey Nsa aff004;  Useni Sani aff004;  Ahmad T. Habibu aff001;  Ibrahim Aliyu aff005;  Tijjani Hussaini aff006;  AbdulRasheed Yusuf aff007;  Yakubu Gida aff008
Působiště autorů: KNCV/Challenge TB, Kano Regional Office, Kano, Nigeria aff001;  Department of Medicine, Bayero University, Kano, Nigeria aff002;  KNCV Tuberculosis Foundation, The Hague, Netherlands aff003;  KNCV Nigeria/ Challenge TB, Country Office, Abuja, Nigeria aff004;  Kano State Tuberculosis and Leprosy Control Program, Kano, Nigeria aff005;  State Ministry of Health, Kano, Nigeria aff006;  Katsina State Tuberculosis and Leprosy Control Program, Katsina, Nigeria aff007;  Bauchi State Tuberculosis and Leprosy Control Program, Bauchi, Nigeria aff008
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225165

Souhrn

Background

Drug-Resistant tuberculosis (DR-TB) is estimated to cause about 10% of all TB related deaths. There is dearth of data on determinants of DR-TB mortality in Nigeria. Death among DR-TB treated cohorts in Nigeria from 2010 to 2013 was 30%, 29%, 15% and 13% respectively. Our objective was to identify factors affecting survival among DR-TB patients in northern Nigeria.

Methods

Demographic and clinical data of all DR-TB patients enrolled in Kano, Katsina and Bauchi states of Nigeria between 1st February 2015 and 30th November 2016 was used. Survival analysis was done using Kaplan-Meier and multiple regression with Cox proportional hazard modeling.

Results

Mean time to death during treatment is 19.2 weeks and 3.9 weeks among those awaiting treatment. Death was recorded among 38 of the 147 DR-TB patients assessed. HIV co-infection significantly increased probability of mortality, with an adjusted hazard ratio (aHR) of 2.35, 95% CI: 1.05–5.29, p = 0.038. Treatment delay showed significant negative association with survival (p = 0.000), not starting treatment significantly reduced probability of survival with an aHR of 7.98, 95% CI: 2.83–22.51, p = 0.000. Adjusted hazard ratios for patients started on treatment more than eight weeks after detection or within two to four weeks after detection, was beneficial though not statistically significant with respective p-values of 0.056 and 0.092. The model of care (facility vs. community-based) did not significantly influence survival.

Conclusion

Both HIV co-infected DR-TB patients and DR-TB patients that fail to start treatment immediately after diagnosis are at significant risk of mortality. Our study showed no significant difference in mortality based on models of care. The study highlights the need to address programmatic and operational issues pertaining to treatment delays and strengthening DR-TB/HIV co-management as key strategies to reduce mortality.

Klíčová slova:

Extensively drug-resistant tuberculosis – HIV diagnosis and management – Multi-drug-resistant tuberculosis – Nigeria – Tuberculosis – Tuberculosis diagnosis and management – Leprosy


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Článek vyšel v časopise

PLOS One


2019 Číslo 11