Chaaba Eutra, Bwembya Josphat, Nyambe Eness, Kumar Ramya, Thior Ibou, Seraphine Kaminsa, Chongwe Gershom, Makwambeni Vimbai, Musonda Victoria, Kasese-Chanda Pauline, Mwinga Alwyn
Ministry of Health, Itezhi-Tezhi District Health Office, Itezhi-Tezhi, Zambia.
USAID Eradicate TB Project, PATH, Lusaka, Zambia.
PLOS Glob Public Health. 2023 Feb 22;3(2):e0001234. doi: 10.1371/journal.pgph.0001234. eCollection 2023.
Itezhi-Tezhi District in southern Zambia has been reporting tuberculosis (TB) mortality rates that are fourfold higher than the national average of six percent. We conducted a retrospective cohort study to establish the demographic and clinical characteristics associated with mortality among persons under treatment for TB in Itezhi-Tezhi District, as well as the likely causes and time to death. We reviewed medical records for persons with TB registered in 19 public health facilities in Itezhi-Tezhi District between January 2015 and December 2018. Of the 506 persons with TB registered in the study period, 426 were included in the analysis. Of these, 71 (16.7%) died before completing treatment. The overall mortality rate was 31.8 per 1,000 person-months of observation. Most of the deaths (53 [74.7%]) occurred in the first month of treatment (median: 16 days; interquartile range: 5-52 days). In a multivariate Cox regression model, type of TB was found to be an independent predictor of mortality while on TB treatment. The risk of dying was more than twice higher for persons with clinically diagnosed PTB compared to those with bacteriologically confirmed PTB (adjusted hazard ratio = 2.2, 95% CI: 1.4-3.6). In a sub-analysis of persons with clinically diagnosed PTB, persons with TB who were on a community-based DOT plan were more than twice more likely to die compared to those on facility-based DOT plan (adjusted hazard ratio = 2.21, 95% CI: 1.1-4.8). Common likely causes of death were pulmonary TB disease (66.0%), anemia (12.8%), cardiac failure (4.3%), pneumocystis jiroveci pneumonia (4.3%), and gastroenteritis (4.2%). These findings show that most deaths occurred during the first month of treatment. Clinical evaluation at initiation of anti-TB treatment and during follow-up care, especially in persons with clinically diagnosed PTB, should include screening and treatment of other conditions.
赞比亚南部的伊泰芝-特芝区报告的结核病死亡率比全国平均水平6%高出四倍。我们开展了一项回顾性队列研究，以确定伊泰芝-特芝区接受结核病治疗的人群中与死亡相关的人口统计学和临床特征，以及可能的死因和死亡时间。我们查阅了2015年1月至2018年12月期间在伊泰芝-特芝区19家公共卫生机构登记的结核病患者的病历。在研究期间登记的506例结核病患者中，426例纳入分析。其中，71例（16.7%）在完成治疗前死亡。总体死亡率为每1000人月观察期31.8例。大多数死亡（53例[74.7%]）发生在治疗的第一个月（中位数：16天；四分位间距：5-52天）。在多变量Cox回归模型中，结核病类型被发现是结核病治疗期间死亡的独立预测因素。与细菌学确诊的肺结核患者相比，临床诊断的肺结核患者死亡风险高出两倍多（调整后风险比=2.2，95%CI：1.4-3.6）。在对临床诊断的肺结核患者的亚分析中，与接受机构直接观察治疗计划的患者相比，接受社区直接观察治疗计划的结核病患者死亡可能性高出两倍多（调整后风险比=2.21，95%CI：1.1-4.8）。常见的可能死因是肺结核病（66.0%）贫血（12.8%）、心力衰竭（4.3%）、耶氏肺孢子菌肺炎（4.3%）和肠胃炎（4.2%）。这些发现表明，大多数死亡发生在治疗的第一个月。抗结核治疗开始时和随访期间的临床评估，尤其是临床诊断的肺结核患者，应包括对其他病症的筛查和治疗。
