Factors associated with mortality among Drug Resistant Tuberculosis patients in Rwanda: A Retrospective study

Abstract

Introduction: Drug Resistant Tuberculosis (DR-TB) is a global public health threat that affects thousands of people every year. The World Health Organization as per the Global tuberculosis report 2018, reported that around 10 million fell ill in 2017, due to tuberculosis disease and among them 558,000 people had drug resistant tuberculosis. This health status is associated with an increasing risk of mortality, much greater while compared to the mortality in sensitive tuberculosis patients. We aimed to assess mortality and risk factors in order to contribute to the reduction of deaths among drug resistant tuberculosis patients in Rwanda. Methods: Our study was a retrospective cohort design and we performed a data analysis using Rwanda National Tuberculosis’s drug resistance tuberculosis excel database that includes patients from July 2014 to December 2017. Socio-demographics and clinical follow up information were collected using an established register at DR-TB centers then recorded electronically in excel database at National Tuberculosis Program. We analyzed using Stata 13 software; bivariate and multiple logistic regression were used to identify potential risk factors. P-values < 0.05 were considered as statistically significant. Results: Overall 279 DR-TB patients were enrolled in drug resistant tuberculosis (DR-TB) centers from July 2014 to December 2017 and the male to female ratio being 2.3 (194/85). The mortality rate in DR-TB patients found was 11.1% (31/279). Multivariate analysis showed that people ≥55 years old are 9 times more likely to die from DR-TB (AOR=9.7; 95%CI [1.19-20.59]), compared to people ≤54 years old with DR-TB. Patients with DR-TB whose time to sputum conversion occur after month two, are around 13 times at risk of death (AOR=13.1; 95% CI [2.9-29.1]), compared to DR-TB patients that sputum converted before month 2. Conclusion: Our study showed that male with DR-TB were double to female and age ≥55 years old, time to sputum conversion occurring after month 2 being risk factors of death in DR-TB patients. Special consideration is needed in management of the elderly patients with DR-TB and those with sputum that do not convert within the first two months of treatment. These interventions might reduce mortality among drug resistance tuberculosis patients in Rwanda.