García-Basteiro Alberto L, Respeito Durval, Augusto Orvalho J, López-Varela Elisa, Sacoor Charfudin, Sequera Victor G, Casellas Aina, Bassat Quique, Manhiça Ivan, Macete Eusebio, Cobelens Frank, Alonso Pedro L
Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique.
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
BMC Infect Dis. 2016 May 20;16:214. doi: 10.1186/s12879-016-1534-y.
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.
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.
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).
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.
在莫桑比克，关于常规监测条件下结核病（TB）治疗结果及不良结局决定因素的监测数据有限。本研究的目的是评估马希卡区（位于莫桑比克南部）结核病患者的治疗结果，分析与致命结局相关的因素，并确定结核病所致死亡在总死亡中的比例。
这是一项基于2011 - 2012年期间确诊的结核病患者的回顾性观察研究。我们使用了三个不同的数据源：a）马希卡区国家结核病控制项目收集的2011 - 2012年期间开始治疗的所有结核病病例的结核病相关变量。b）通过莫桑比克国家统计局获得该地区的人口估计数。c）从马希卡健康研究中心的健康与人口监测系统收集死亡及其他相关人口统计学变量。采用世界卫生组织的指南来定义结核病病例和治疗结果。
在2011 - 2012年期间开始结核病治疗的1957例病例中，294例患者（15.1%）在抗结核治疗期间死亡。10%的患者中断治疗。被认为治疗失败的患者比例为1.1%。艾滋病毒感染（比值比2.73；95%置信区间：1.70 - 4.38）、男性（比值比：1.39；95%置信区间1.01 - 1.91）以及缺乏实验室确诊（比值比：1.54；95%置信区间1.12 - 2.13）与结核病治疗过程中的死亡相关（p值<0.05）。结核病对该地区自然原因导致的总死亡负担的贡献为6.5%（95%置信区间：5.5 - 7.6），男性高于女性（分别为7.8%；95%置信区间：6.1 - 9.5和5.4%；95%置信区间：4.1 - 6.8）。结核病导致死亡比例最高的年龄组，男性为30 - 34岁，女性为20 - 24岁（两种情况均占所有死亡的20%）。
本研究表明开始治疗的结核病病例中致命结局比例非常高。结核病对总死亡原因有很大贡献。这些结果呼吁采取行动以改善结核病（以及结核病/艾滋病毒）的管理，从而改善结核病患者的治疗结果。
