Tuberculosis Mortality in Lusaka, Zambia, 2016; Old Age, Health Facility Type and HIV Co-Infection as Associated Factors

  • Viral hepatitis and HIV
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Background:
Lusaka is among the districts with high Tuberculosis (TB) notifications in Zambia, and the mortality proportion (6%) was exceeding the national target of less than 5% in the year 2015. Thus, we sought to look at risk factors for TB mortality among the routinely collected programmatic TB data in public health facilities.
Methods:
We conducted a cross-sectional study in three purposively selected public health facilities in Lusaka; a 1stlevel hos- pital, an urban-clinic, and a peri-urban-clinic. We defined TB mortality as any TB patient who died for any reason during the course of treatment. We abstracted data from treatment registers for all TB cases on treatment from 1st January - 31st December 2016. We calculated mortality proportions for each facility. We used multivariable logistic regression to analyse the associations between TB mortality and age, health facility type or HIV status and reported adjusted odds ratios (AOR), and 95% confidence intervals (CI).
Results:
We included 1,218 registered TB patients from the urban-clinic (43%), 1st level hospital (44%) and peri-urban-clinic (13%). Overall mortality proportion was 8%, and by facility: 7% (urban-clinic), 10% (1st level hospital) and 5% (peri- urban-clinic). The odds of TB mortality were higher among patients >64 years (AOR=7.5, 95%CI:1.9–29.0), patients who sought treatment at the 1stlevel hospital (AOR=1.6, 95%CI:1.1–2.4), and TB/HIV co-infected patients (AOR=3.0, 95%CI:1.9–4.9).
Conclusion
TB Mortality in the selected facilities was high compared to the national target. We recommended close monitoring of patients >64years old, and those who are HIV-positive, during the course of TB treatment. Prospective studies are needed to further understand the differences in mortality by health facility type, as well as identify and test targeted interventions to reduce mortality among TB patients.

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