Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana
Identifieur interne : 000900 ( Main/Exploration ); précédent : 000899; suivant : 000901Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana
Auteurs : Nicole T. Burton [États-Unis] ; Audrey Forson [Ghana] ; Mark N. Lurie [États-Unis] ; Samuel Kudzawu [Ghana] ; Ernest Kwarteng [Ghana] ; Awewura Kwara [États-Unis]Source :
- Transactions of the Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 2011.
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- Pascal (Inist)
- Wicri :
English descriptors
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Abstract
Tuberculosis (TB) remains a major cause of mortality despite availability of effective chemotherapy. This study was performed to identify contributing factors for poor outcome during anti-tuberculosis treatment at a teaching hospital chest clinic. Medical records of registered patients treated forTB between 1 January and 31 December, 2009 were reviewed and abstracted for demographic, clinical and outcome data. Risk factors for mortality during therapy were assessed using bivariate and multivariate logistics approaches. Of 599 patients, 355 (58.9%) completed therapy and/or were cured, 192 (32.1%) died, and 39 (6.5%) defaulted. In multivariate analysis, independent risk factors for mortality included pulmonary cases for which sputum smear status was unknown (odds ratio [OR] 13.7: 95% confidence interval [CI] 6.0, 31.4), HIV coinfection (OR, 3.6; 95% CI 2.4, 5.4), disseminated TB (OR, 2.2: 95% CI 1.0, 4.9), TB meningitis (OR, 2.8; 95% CI 1.5, 5.3), not having a treatment supporter (OR, 2.0; 95% CI 1.3, 3.1), and low body weight (OR, 11.0; 95% CI 3.1, 38.6). Not having a treatment supporter (OR, 3.2; 95% CI 1.6, 6.6) and HIV coinfection (OR, 2.4; 95% CI 1.2, 5.2) were also independently associated with treatment default. Our findings suggest that enhanced measures to reduce mortality and default in TB patients with HIV coinfection, disseminated or meningeal disease and those who have no treatment supporters may help improve treatment outcomes in Ghana.
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Box 77</s1><s2>Korle Bu, Accra</s2><s3>GHA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Ghana</country><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Lurie, Mark N" sort="Lurie, Mark N" uniqKey="Lurie M" first="Mark N." last="Lurie">Mark N. 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Box 77</s1><s2>Korle Bu, Accra</s2><s3>GHA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Ghana</country><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Kwara, Awewura" sort="Kwara, Awewura" uniqKey="Kwara A" first="Awewura" last="Kwara">Awewura Kwara</name><affiliation wicri:level="2"><inist:fA14 i1="03"><s1>Department of Medicine, The Miriam Hospital, 164 Summit Avenue, RISE Building</s1><s2>Providence, R102906</s2><s3>USA</s3><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Rhode Island</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>Warren Alpert Medical School of Brown University, Brown University, Box G-A</s1><s2>Providence, RI 02912</s2><s3>USA</s3><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Rhode Island</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Transactions of the Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbreviated">Trans. r. soc. trop. med. hyg.</title><idno type="ISSN">0035-9203</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Transactions of the Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbreviated">Trans. r. soc. trop. med. hyg.</title><idno type="ISSN">0035-9203</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Ghana</term><term>Human</term><term>Mortality</term><term>Prognosis</term><term>Teaching hospital</term><term>Treatment</term><term>Tropical medicine</term><term>Tuberculosis</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Tuberculose</term><term>SIDA</term><term>Mortalité</term><term>Centre hospitalier universitaire</term><term>Ghana</term><term>Homme</term><term>Traitement</term><term>Pronostic</term><term>Médecine tropicale</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Mortalité</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Tuberculosis (TB) remains a major cause of mortality despite availability of effective chemotherapy. This study was performed to identify contributing factors for poor outcome during anti-tuberculosis treatment at a teaching hospital chest clinic. Medical records of registered patients treated forTB between 1 January and 31 December, 2009 were reviewed and abstracted for demographic, clinical and outcome data. Risk factors for mortality during therapy were assessed using bivariate and multivariate logistics approaches. Of 599 patients, 355 (58.9%) completed therapy and/or were cured, 192 (32.1%) died, and 39 (6.5%) defaulted. In multivariate analysis, independent risk factors for mortality included pulmonary cases for which sputum smear status was unknown (odds ratio [OR] 13.7: 95% confidence interval [CI] 6.0, 31.4), HIV coinfection (OR, 3.6; 95% CI 2.4, 5.4), disseminated TB (OR, 2.2: 95% CI 1.0, 4.9), TB meningitis (OR, 2.8; 95% CI 1.5, 5.3), not having a treatment supporter (OR, 2.0; 95% CI 1.3, 3.1), and low body weight (OR, 11.0; 95% CI 3.1, 38.6). Not having a treatment supporter (OR, 3.2; 95% CI 1.6, 6.6) and HIV coinfection (OR, 2.4; 95% CI 1.2, 5.2) were also independently associated with treatment default. Our findings suggest that enhanced measures to reduce mortality and default in TB patients with HIV coinfection, disseminated or meningeal disease and those who have no treatment supporters may help improve treatment outcomes in Ghana.</div></front></TEI><affiliations><list><country><li>Ghana</li><li>États-Unis</li></country><region><li>Rhode Island</li><li>Région du Grand Accra</li></region><settlement><li>Accra</li></settlement></list><tree><country name="États-Unis"><region name="Rhode Island"><name sortKey="Burton, Nicole T" sort="Burton, Nicole T" uniqKey="Burton N" first="Nicole T." last="Burton">Nicole T. Burton</name></region><name sortKey="Kwara, Awewura" sort="Kwara, Awewura" uniqKey="Kwara A" first="Awewura" last="Kwara">Awewura Kwara</name><name sortKey="Kwara, Awewura" sort="Kwara, Awewura" uniqKey="Kwara A" first="Awewura" last="Kwara">Awewura Kwara</name><name sortKey="Lurie, Mark N" sort="Lurie, Mark N" uniqKey="Lurie M" first="Mark N." last="Lurie">Mark N. Lurie</name></country><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Forson, Audrey" sort="Forson, Audrey" uniqKey="Forson A" first="Audrey" last="Forson">Audrey Forson</name></region><name sortKey="Kudzawu, Samuel" sort="Kudzawu, Samuel" uniqKey="Kudzawu S" first="Samuel" last="Kudzawu">Samuel Kudzawu</name><name sortKey="Kwarteng, Ernest" sort="Kwarteng, Ernest" uniqKey="Kwarteng E" first="Ernest" last="Kwarteng">Ernest Kwarteng</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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