Factors contributing to mortality among new tuberculosis patients in the Zululand health district, South Africa: A retrospective study

Abstract

There is high mortality among newly diagnosed Tuberculosis (TB) patients in Zululand Health District. This study examined factors contributing to TB mortality in Zululand Health District, KwaZulu-Natal Province, South Africa between January 2012 and December 2013. This was a retrospective review of electronic TB database of 12,829 patients enrolled between January 2012 and December 2013 on the electronic TB data base in Zululand Health District. Data was analysed using descriptive and inferential statistics. The multivariate and adjusted odds ratio (OR), together with their corresponding 95% confidence intervals (CI), were estimated. Of the 12829 patients on the electronic TB data base, 1318 patients died and 80% of these mortalities were HIV positive. Poor CD4 cell count monitoring, delay in initiation of antiretroviral therapy (ART) or non-initiation of ART to newly diagnosed TB/HIV comorbid patients were associated with mortality (p < 0.0001, OR=0.51). There was significant association between mortality and failure to initiate comorbid patients on co-trimoxazole prophylaxis ( X² =9.1; df=1; p=0.0025). Patients whose smear tested negative were significantly less likely to survive death as compared to those whose smears were positive (OR=0.81; 95% CI=0.75-0.91). Patients who were yet to initiate cotrimoxazole (CPT) prophylaxis were less likely to survive death as compared to those who were on CPT (OR=0.73; CI= 0.59-0.89). Patients who were not on direct observation of treatment (DOT) had lower chances of survival as compared to those on DOT (OR=0.81; CI = 0.71-0.91). There was significant association between HIV positivity and mortality (OR =1.75; CI = 0.51-0.78). There was significant association between low CD4 cell count and TB mortality across all genders. Significant association existed between non-initiation of ART patients and TB mortality (OR=1.30; CI= 1.07-1.56. Seemingly, TB and HIV comorbidity and delays or failure to initiate positive patients on ART were the main factors responsible for newly TB associated mortality in Zululand Health District.

Keywords: Tuberculosis mortality, HIV patients, CD4 cell count, antiretroviral therapy, HIV comorbidity, South Africa