Temporal trends in death causes in adults attending an urban HIV clinic in Uganda: a retrospective chart review
Identifieur interne : 000D70 ( Main/Exploration ); précédent : 000D69; suivant : 000D71Temporal trends in death causes in adults attending an urban HIV clinic in Uganda: a retrospective chart review
Auteurs : Janneke A. Cox [Belgique] ; Daniel Kiggundu [Ouganda] ; Lana Elpert [États-Unis] ; Graeme Meintjes [Afrique du Sud] ; Robert Colebunders [Belgique] ; Stella Alamo [Ouganda]Source :
- BMJ Open [ 2044-6055 ] ; 2016.
Abstract
To study temporal trends of mortality in HIV-infected adults who attended an HIV clinic in Kampala, Uganda, between 2002 and 2012.
Descriptive retrospective study.
Two doctors independently reviewed the clinic database that contained information derived from the clinic files and assigned one or more causes of death to each patient >18 years of age with a known date of death. Four cause-of-death categories were defined: ‘communicable conditions and AIDS-defining malignancies’, ‘chronic non-communicable conditions’, ‘other non-communicable conditions’ and ‘unknown’. Trends in cause-of-death categories over time were evaluated using multinomial logistic regression with year of death as an independent continuous variable.
1028 deaths were included; 38% of these individuals were on antiretroviral therapy (ART). The estimated mortality rate dropped from 21.86 deaths/100 person years of follow-up (PYFU) in 2002 to 1.75/100 PYFU in 2012. There was a significant change in causes of death over time (p<0.01). Between 2002 and 2012, the proportion of deaths due to ‘communicable conditions and AIDS-defining malignancies’ decreased from 84% (95% CI 74% to 90%) to 64% (95% CI 53% to 74%) and the proportion of deaths due to ‘chronic non-communicable conditions’, ‘other non-communicable conditions’ and a combination of ‘communicable and non-communicable conditions’ increased. Tuberculosis (TB) was the main cause of death (34%). Death from TB decreased over time, from 43% (95% CI 32% to 53%) in 2002 to a steady proportion of approximately 25% from 2006 onwards (p<0.01).
Mortality rate decreased over time. The proportion of deaths from communicable conditions and AIDS-defining malignancies decreased and from non-communicable diseases, both chronic and non-chronic, increased. Nevertheless, communicable conditions and AIDS-defining malignancies continued to cause the majority of deaths, with TB as the main cause. Ongoing monitoring of cause of death is warranted and strategies to decrease mortality from TB and other common opportunistic infections are essential.
Url:
DOI: 10.1136/bmjopen-2015-008718
PubMed: 26739722
PubMed Central: 4716149
Affiliations:
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Cox</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Clinical Sciences</addr-line>,<institution>Institute of Tropical Medicine</institution>,<addr-line>Antwerp</addr-line>,<country>Belgium</country></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Kiggundu, Daniel" sort="Kiggundu, Daniel" uniqKey="Kiggundu D" first="Daniel" last="Kiggundu">Daniel Kiggundu</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Medicine</addr-line>,<institution>Makerere University College of Health Sciences</institution>,<addr-line>Kampala</addr-line>,<country>Uganda</country></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Elpert, Lana" sort="Elpert, Lana" uniqKey="Elpert L" first="Lana" last="Elpert">Lana Elpert</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Department of Medicine</addr-line>,<institution>Johns Hopkins University School of Medicine</institution>,<addr-line>Baltimore, Maryland</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Meintjes, Graeme" sort="Meintjes, Graeme" uniqKey="Meintjes G" first="Graeme" last="Meintjes">Graeme Meintjes</name><affiliation wicri:level="1"><nlm:aff id="af4"><addr-line>Department of Medicine</addr-line>,<institution>Institute of Infectious Disease, University of Cape Town</institution>,<addr-line>Cape Town</addr-line>,<country>South Africa</country></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Colebunders, Robert" sort="Colebunders, Robert" uniqKey="Colebunders R" first="Robert" last="Colebunders">Robert Colebunders</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Clinical Sciences</addr-line>,<institution>Institute of Tropical Medicine</institution>,<addr-line>Antwerp</addr-line>,<country>Belgium</country></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Faculty of Medicine</addr-line>,<institution>University of Antwerp</institution>,<addr-line>Antwerp</addr-line>,<country>Belgium</country></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alamo, Stella" sort="Alamo, Stella" uniqKey="Alamo S" first="Stella" last="Alamo">Stella Alamo</name><affiliation wicri:level="1"><nlm:aff id="af6"><institution>Reach Out Mbuya Parish HIV/AIDS Initiative</institution>,<addr-line>Kampala</addr-line>,<country>Uganda</country></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26739722</idno><idno type="pmc">4716149</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716149</idno><idno type="RBID">PMC:4716149</idno><idno type="doi">10.1136/bmjopen-2015-008718</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000326</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000326</idno><idno type="wicri:Area/Pmc/Curation">000326</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000326</idno><idno type="wicri:Area/Pmc/Checkpoint">000455</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000455</idno><idno type="wicri:Area/Ncbi/Merge">003538</idno><idno type="wicri:Area/Ncbi/Curation">003538</idno><idno type="wicri:Area/Ncbi/Checkpoint">003538</idno><idno type="wicri:Area/Main/Merge">000D70</idno><idno type="wicri:Area/Main/Curation">000D70</idno><idno type="wicri:Area/Main/Exploration">000D70</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Temporal trends in death causes in adults attending an urban HIV clinic in Uganda: a retrospective chart review</title><author><name sortKey="Cox, Janneke A" sort="Cox, Janneke A" uniqKey="Cox J" first="Janneke A" last="Cox">Janneke A. Cox</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Clinical Sciences</addr-line>,<institution>Institute of Tropical Medicine</institution>,<addr-line>Antwerp</addr-line>,<country>Belgium</country></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Kiggundu, Daniel" sort="Kiggundu, Daniel" uniqKey="Kiggundu D" first="Daniel" last="Kiggundu">Daniel Kiggundu</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Medicine</addr-line>,<institution>Makerere University College of Health Sciences</institution>,<addr-line>Kampala</addr-line>,<country>Uganda</country></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Elpert, Lana" sort="Elpert, Lana" uniqKey="Elpert L" first="Lana" last="Elpert">Lana Elpert</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Department of Medicine</addr-line>,<institution>Johns Hopkins University School of Medicine</institution>,<addr-line>Baltimore, Maryland</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Meintjes, Graeme" sort="Meintjes, Graeme" uniqKey="Meintjes G" first="Graeme" last="Meintjes">Graeme Meintjes</name><affiliation wicri:level="1"><nlm:aff id="af4"><addr-line>Department of Medicine</addr-line>,<institution>Institute of Infectious Disease, University of Cape Town</institution>,<addr-line>Cape Town</addr-line>,<country>South Africa</country></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Colebunders, Robert" sort="Colebunders, Robert" uniqKey="Colebunders R" first="Robert" last="Colebunders">Robert Colebunders</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Clinical Sciences</addr-line>,<institution>Institute of Tropical Medicine</institution>,<addr-line>Antwerp</addr-line>,<country>Belgium</country></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Faculty of Medicine</addr-line>,<institution>University of Antwerp</institution>,<addr-line>Antwerp</addr-line>,<country>Belgium</country></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alamo, Stella" sort="Alamo, Stella" uniqKey="Alamo S" first="Stella" last="Alamo">Stella Alamo</name><affiliation wicri:level="1"><nlm:aff id="af6"><institution>Reach Out Mbuya Parish HIV/AIDS Initiative</institution>,<addr-line>Kampala</addr-line>,<country>Uganda</country></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMJ Open</title><idno type="eISSN">2044-6055</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>To study temporal trends of mortality in HIV-infected adults who attended an HIV clinic in Kampala, Uganda, between 2002 and 2012.</p></sec><sec><title>Design</title><p>Descriptive retrospective study.</p></sec><sec><title>Methods</title><p>Two doctors independently reviewed the clinic database that contained information derived from the clinic files and assigned one or more causes of death to each patient >18 years of age with a known date of death. Four cause-of-death categories were defined: ‘communicable conditions and AIDS-defining malignancies’, ‘chronic non-communicable conditions’, ‘other non-communicable conditions’ and ‘unknown’. Trends in cause-of-death categories over time were evaluated using multinomial logistic regression with year of death as an independent continuous variable.</p></sec><sec><title>Results</title><p>1028 deaths were included; 38% of these individuals were on antiretroviral therapy (ART). The estimated mortality rate dropped from 21.86 deaths/100 person years of follow-up (PYFU) in 2002 to 1.75/100 PYFU in 2012. There was a significant change in causes of death over time (p<0.01). Between 2002 and 2012, the proportion of deaths due to ‘communicable conditions and AIDS-defining malignancies’ decreased from 84% (95% CI 74% to 90%) to 64% (95% CI 53% to 74%) and the proportion of deaths due to ‘chronic non-communicable conditions’, ‘other non-communicable conditions’ and a combination of ‘communicable and non-communicable conditions’ increased. Tuberculosis (TB) was the main cause of death (34%). Death from TB decreased over time, from 43% (95% CI 32% to 53%) in 2002 to a steady proportion of approximately 25% from 2006 onwards (p<0.01).</p></sec><sec><title>Conclusions</title><p>Mortality rate decreased over time. The proportion of deaths from communicable conditions and AIDS-defining malignancies decreased and from non-communicable diseases, both chronic and non-chronic, increased. Nevertheless, communicable conditions and AIDS-defining malignancies continued to cause the majority of deaths, with TB as the main cause. Ongoing monitoring of cause of death is warranted and strategies to decrease mortality from TB and other common opportunistic infections are essential.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Baggaley, R" uniqKey="Baggaley R">R Baggaley</name></author><author><name sortKey="Hensen, B" uniqKey="Hensen B">B Hensen</name></author><author><name sortKey="Ajose, O" uniqKey="Ajose O">O Ajose</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kasamba, I" uniqKey="Kasamba I">I Kasamba</name></author><author><name sortKey="Baisley, K" uniqKey="Baisley K">K Baisley</name></author><author><name sortKey="Mayanja, Bn" uniqKey="Mayanja B">BN Mayanja</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lawn, Sd" uniqKey="Lawn S">SD 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Cox</name></noRegion><name sortKey="Colebunders, Robert" sort="Colebunders, Robert" uniqKey="Colebunders R" first="Robert" last="Colebunders">Robert Colebunders</name><name sortKey="Colebunders, Robert" sort="Colebunders, Robert" uniqKey="Colebunders R" first="Robert" last="Colebunders">Robert Colebunders</name></country><country name="Ouganda"><noRegion><name sortKey="Kiggundu, Daniel" sort="Kiggundu, Daniel" uniqKey="Kiggundu D" first="Daniel" last="Kiggundu">Daniel Kiggundu</name></noRegion><name sortKey="Alamo, Stella" sort="Alamo, Stella" uniqKey="Alamo S" first="Stella" last="Alamo">Stella Alamo</name></country><country name="États-Unis"><noRegion><name sortKey="Elpert, Lana" sort="Elpert, Lana" uniqKey="Elpert L" first="Lana" last="Elpert">Lana Elpert</name></noRegion></country><country name="Afrique du Sud"><noRegion><name sortKey="Meintjes, Graeme" sort="Meintjes, Graeme" uniqKey="Meintjes G" first="Graeme" last="Meintjes">Graeme Meintjes</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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