The timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South India

Hdl Handle:
http://hdl.handle.net/10144/213252
Title:
The timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South India
Authors:
Jonnalagada, Subbanna; Harries, Anthony D; Zachariah, Rony; Satyanarayana, Srinath; Tetali, Shailaja; Keshav Chander, G; Rao, Srinivas; Rao, Ranganadha; Peri, Sundaresh; Anchala, Raghupathy; Kannuri, Nanda K
Journal:
BMC Public Health
Abstract:
Background: India has 2.0 million estimated tuberculosis (TB) cases per annum with an estimated 280,000 TBrelated deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India:- i) treatment outcomes including the number who died while on treatment, ii) the month of death and iii) characteristics associated with “early” death, occurring in the initial 8 weeks of treatment. Methods: This was a retrospective study in 16 selected Designated Microscopy Centres (DMCs) in Hyderabad, Krishna and Adilabad districts of Andhra Pradesh, South India. A review was performed of treatment cards and medical records of all TB patients (adults and children) registered and placed on standardized anti-tuberculosis treatment from January 2005 to September 2009. Results: There were 8,240 TB patients (5183 males) of whom 492 (6%) were known to have died during treatment. Case-fatality was higher in those previously treated (12%) and lower in those with extra-pulmonary TB (2%). There was an even distribution of deaths during anti-tuberculosis treatment, with 28% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with “early death”. Conclusion: In this large cohort of TB patients, deaths occurred with an even frequency throughout anti-TB treatment. Reasons may relate to i) the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii) co-morbidities, such as HIV/ AIDS and diabetes mellitus, which are known to influence mortality. More research in this area from prospective and retrospective studies is needed.
Affiliation:
LEPRA India - Blue Peter Public Health & Research Centre, Andhra Pradesh, India; International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK; Medecins Sans Frontieres, Medical Department (Operational Research), Operational Center, Brussels, Luxembourg; International Union against Tuberculosis and Lung Diseases (The Union), South East Asia, Regional Office, New Delhi, India; Public Health Foundation of India – Indian Institute of Public Health, Amar, Co-op Society Hyderabad, India; Department of Health & Family Welfare, Government of Andhra Pradesh, Koti, Sultan, Bazar, Hyderabad, India; State TB Office, Department of Health Services, Government of Andhra Pradesh, Koti, Sultan Bazar, Hyderabad, India; LEPRA India, Krishnapuri colony, West Marredpally, Hyderabad, India; Public Health Foundation of India - Indian Institute of Public Health, Hyderabad, India
Publisher:
BioMed Central
Issue Date:
13-Dec-2011
URI:
http://hdl.handle.net/10144/213252
DOI:
10.1186/1471-2458-11-921
Additional Links:
http://www.biomedcentral.com/1471-2458/11/921
Type:
Article
Language:
en
ISSN:
1471-2458
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorJonnalagada, Subbannaen
dc.contributor.authorHarries, Anthony Den
dc.contributor.authorZachariah, Ronyen
dc.contributor.authorSatyanarayana, Srinathen
dc.contributor.authorTetali, Shailajaen
dc.contributor.authorKeshav Chander, Gen
dc.contributor.authorRao, Srinivasen
dc.contributor.authorRao, Ranganadhaen
dc.contributor.authorPeri, Sundareshen
dc.contributor.authorAnchala, Raghupathyen
dc.contributor.authorKannuri, Nanda Ken
dc.date.accessioned2012-02-28T06:25:14Z-
dc.date.available2012-02-28T06:25:14Z-
dc.date.issued2011-12-13-
dc.identifier.citationBMC Public Health 2011; 11:921en
dc.identifier.issn1471-2458-
dc.identifier.doi10.1186/1471-2458-11-921-
dc.identifier.urihttp://hdl.handle.net/10144/213252-
dc.description.abstractBackground: India has 2.0 million estimated tuberculosis (TB) cases per annum with an estimated 280,000 TBrelated deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India:- i) treatment outcomes including the number who died while on treatment, ii) the month of death and iii) characteristics associated with “early” death, occurring in the initial 8 weeks of treatment. Methods: This was a retrospective study in 16 selected Designated Microscopy Centres (DMCs) in Hyderabad, Krishna and Adilabad districts of Andhra Pradesh, South India. A review was performed of treatment cards and medical records of all TB patients (adults and children) registered and placed on standardized anti-tuberculosis treatment from January 2005 to September 2009. Results: There were 8,240 TB patients (5183 males) of whom 492 (6%) were known to have died during treatment. Case-fatality was higher in those previously treated (12%) and lower in those with extra-pulmonary TB (2%). There was an even distribution of deaths during anti-tuberculosis treatment, with 28% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with “early death”. Conclusion: In this large cohort of TB patients, deaths occurred with an even frequency throughout anti-TB treatment. Reasons may relate to i) the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii) co-morbidities, such as HIV/ AIDS and diabetes mellitus, which are known to influence mortality. More research in this area from prospective and retrospective studies is needed.en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.relation.urlhttp://www.biomedcentral.com/1471-2458/11/921en
dc.rightsArchived with thanks to BMC Public Healthen
dc.subject.meshTuberculosisen
dc.titleThe timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South Indiaen
dc.typeArticleen
dc.contributor.departmentLEPRA India - Blue Peter Public Health & Research Centre, Andhra Pradesh, India; International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK; Medecins Sans Frontieres, Medical Department (Operational Research), Operational Center, Brussels, Luxembourg; International Union against Tuberculosis and Lung Diseases (The Union), South East Asia, Regional Office, New Delhi, India; Public Health Foundation of India – Indian Institute of Public Health, Amar, Co-op Society Hyderabad, India; Department of Health & Family Welfare, Government of Andhra Pradesh, Koti, Sultan, Bazar, Hyderabad, India; State TB Office, Department of Health Services, Government of Andhra Pradesh, Koti, Sultan Bazar, Hyderabad, India; LEPRA India, Krishnapuri colony, West Marredpally, Hyderabad, India; Public Health Foundation of India - Indian Institute of Public Health, Hyderabad, Indiaen
dc.identifier.journalBMC Public Healthen
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