High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 94; no. 3; pp. 305 - 309
• Main Authors: Kang'ombe, C., Harries, A.D., Banda, H., Nyangulu, D.S., Whitty, C.J.M., Salaniponi, F.M.L., Maher, D., Nunn, P.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-05-2000; Royal Society of Tropical Medicine and Hygiene; Elsevier
• Subjects: Adolescent; Adult; Aged; AIDS/HIV; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Child; Child, Preschool; Cohort Studies; extrapulmonary tuberculosis; Female; Follow-Up Studies; HIV Seropositivity - epidemiology; HIV Seroprevalence; Human bacterial diseases; human immunodeficiency virus; Humans; Infant; Infant, Newborn; Infectious diseases; Malawi; Malawi - epidemiology; Male; Medical sciences; Middle Aged; mortality; Mycobacterium tuberculosis; Prospective Studies; Risk Factors; smear-negative tuberculosis; smear-positive tuberculosis; Survival Analysis; Tropical medicine; tuberculosis; Tuberculosis - drug therapy; Tuberculosis - mortality; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - mortality; Malawi; Africa; smear-negative tuberculosis; Mycobacterium tuberculosis; Malawi; smear-positive tuberculosis; extrapulmonary tuberculosis; tuberculosis; human immunodeficiency virus; mortality; Infection; Human; Immunopathology; Tuberculosis; Viral disease; Mortality; Bacteriosis; AIDS; Mycobacterial infection; Immune deficiency; Epidemiology
• DOI: 10.1016/S0035-9203(00)90335-3
• EISSN: 1878-3503
• ISSN: 0035-9203

There is little information about long-term follow-up in patients with smear-negative pulmonary tuberculosis (PTB) or extrapulmonary tuberculosis (EPTB) who have been treated under routine programme conditions in sub-Saharan Africa. A prospective study was carried out to determine outcome 32 months from start of treatment in an unselected cohort of 827 adult TB inpatients registered at Zomba Hospital, Malawi, in 1 July–31 December 1995. By 32 months, 351 (42%) patients had died. Death rates were 30% (95% confidence interval [95% CI] 25–35%) in 386 patients with smear-positive PTB, 60% (95% CI 53–67%) in 211 patients with smear-negative PTB and 47% (95% CI 40–54%) in 230 patients with EPTB. Of the 793 patients with concordant HIV test results 612 (77%) were HIV seropositive: 47% HIV-positive patients were dead by 32 months compared with 27% HIV-negative patients (adjusted hazard ratio [HR] 2·3; 95% CI 1·7-3·1,
P < 0·001). Smear-negative PTB patients had the highest death rates during the 32-month follow-up (HR 2·7; 95% CI 2·1–3·5,
P < 0·001 compared to smear-positive patients), followed by EPTB patients (HR 1·9; 95% CI 1·5-2·5,
P < 0·001 compared to smear-positive patients). When analysis was restricted to after the treatment period had finished (i.e., months 12–32), the differences in mortality were maintained for HIV-serostatus and for types of TB. Low-cost, easy to implement strategies for reducing mortality in HIV-positive TB patients in sub-Saharan Africa (such as the use of trimethoprim-sulphamethoxazole prophylaxis) need to be tested urgently in programme settings.