Rates and Risk Factors for Mortality among Tuberculosis Patients on Directly Observed Therapy in Rural Primary Health Care Centres in Ogun State, Nigeria

Abstract

This study was designed to identify risk factors associated with mortality during TB treatment and report on other treatment outcome within the National tuberculosis and leprosy treatment control programme (NTBLCP) programme in rural primary health care centres in Nigeria. Retrospective, cohort study. This study was carried out at the PHC Units in the ljebu North Local Government Area of Ogun State. A cohort of all TB patients attending clinic for treatment from 1st April 2004 to 30th June 2007 was used. The information was collected from the facility record using a data collection form. A total sample of 938 patients was reviewed. The overall mortality rate among the TB patients was 13.1% and was 40.3% of the entire poor treatment outcome. In all, 633 [67.5%] of all the cases completed treatment and were cured, 135 (14.4%) defaulted and 47 [5.0%] had treatment failure and 123 [13.1%] died during treatment. Mortality rate was significantly higher among those with relapse [RR=2.24,CI=1.45-3.46],returned after default [RR=2.27, CI=1.43-3.48] and with HIV/AIDS infection (RR=6.10, 3.50-10.64). Among those that died, significant majority 100 [81.3%] of the patients died within the first 2 months (intensive phase of therapy) of presentation at the PHC centres (p=0.000) with 79 [64.2%] being from new cases, 20 [16.3%] from those with Relapse and 19 [15.4%] from defaulters. The study implies that patients infected with HIV/AIDS, those who return after default or had a relapse presented with a higher mortality rate. Prevention of HIV/AIDS, default from treatment and TB relapse are essential in order to reduce mortality due to tuberculosis in a high incidence community such as this study population.

Keywords: Rates, Risk factors, Tuberculosis, Primary health care centers, DOTS, Nigeria

Nigerian Medical Practitioner Vol. 63 No 4, 2013