article: 54

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54 ["PO 8417\u2005RISING TRENDS IN TB MORTALITY AMID DECLINE IN CASES NOTIFIED IN A RURAL COUNTY IN KENYA: COHORT STUDY"] 10.1136/bmjgh-2019-edc.89 http://dx.doi.org/10.1136/bmjgh-2019-edc.89 2019-04-24T15:32:16Z [] 0 0 ["2059-7908"] BMJ Global Health <jats:sec><jats:title>Background</jats:title><jats:p>Despite introduction of rapid and accurate diagnostic tools and aggressive treatment for tuberculosis (TB), it is still a global health problem. In 2016, globally, 1.7 million people died of TB, 95% from resource-poor countries. This study aimed to estimate changing trends in all-cause mortality rate and identify features associated with mortality among suspected TB patients on treatment.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A cohort study of patients registered in a TB surveillance system from 2012 to 2016 and followed up for six months during TB treatment. The outcome was all-cause mortality within six months of TB treatment. The exposures examined were demographic and clinical features at the time of starting TB treatment.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 10,717 participants, median (IQR) age 33 (24–45) years, of which 3163 (30%) were HIV-infected were included in the analyses. During follow-up of 5175.5 person-years (PY), 585/10,717 (5.5%) participants died; mortality rate was 12.2 (95% CI 11.3,13.3) deaths per 100PY. The yearly mortality rate increased from 7.79 (95% CI 6.35, 9.54) in 2012 to 17.73 (95% CI 14.93, 21.06) in 2016 per 100PY (P<jats:sub>trend</jats:sub> &lt;0.001) but the number of suspected-TB notifications declined from 2610 (24%) in 2012 to 1689 (16%) in 2016 (P<jats:sub>trend</jats:sub>=0.02). 77% of all deaths occurred by month three. Mortality among HIV-infected participants was higher (325/3163; 10.3%) than among HIV-non-infected participants (251/7413; 3.4%; p&lt;0.001). Old age, being a female, type of TB diagnosis used, body mass index (BMI) &lt;18.5, HIV status and year of diagnosis were associated with mortality in the multivariate regression model.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This large population level TB study identifies an alarming trend of patients dying within months of starting treatment. These early deaths could be due to late diagnosis and multidrug-resistance. The study warrants further investigation to go beyond already established indicators which remained constant (including HIV co-infection), to explore host, disease or health system related factors that may explain the observed trend.</jats:p></jats:sec> 5 [] ["Moses Ngari", "Osman Abdullahi", "Deche Sanga", "Geoffrey Katana", "Annie Willetts"] [""] [""] [""]