Factors associated with tuberculosis mortality in selected health facilities in Lusaka, Zambia, 2016

Abstract

Introduction: Zambia is among the 30 countries with the highest burden of tuberculosis (TB), with an estimated incidence rate of 346 per 100,000 population in 2018. Lusaka is among the districts with the highest TB incidence in Zambia. In 2015, TB mortality (6%) exceeded the national target of less than 5%. We sought to assess factors associated with TB mortality in selected public health facilities in Lusaka, in order to gain knowledge required to design appropriate strategies for reduction.
Methods: We conducted a cross-sectional study in three purposively selected public health facilities in Lusaka including a 1st level-hospital, an urban-clinic, and a periurban clinic. We used the 2013 World Health Organisation's (WHO), definitions and reporting framework for TB and defined TB mortality as any TB patient who died for any reason during the course of TB treatment. We abstracted data from treatment registers for TB cases on treatment in 2016. Using multivariable logistic regression, we analysed 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 1,537 registered TB patients from the three sites in 2016 (urbanclinic(n=676), 1st-level-hospital(n=630) and peri-urban-clinic(n=231)). The overall mortality rate was 9%, and by facility: 8%(urban-clinic), 11%(1st-level-hospital) and 8%(peri-urban-clinic). The odds of TB mortality were higher among patients >64 years (AOR=7.6, 95%CI:1.97–29.55), TB/HIV co-infected (AOR=3.1, 95%CI:1.91–4.93) and those treated at the 1st-level-hospital (AOR=1.6, 95%CI:1.08–2.40).
Conclusion: TB mortality in the selected facilities was high compared to the national target. We recommend scaling up of TB treatment and preventive therapy among people living HIV especially those >64 years old in the selected health facilities.