Factors associated with mortality in TB patients on first-line treatment in Rwanda from July 2019 to June 2022

Abstract

Introduction: Tuberculosis (TB) is a significant cause of mortality worldwide, and Rwanda is no exception. Although the availability of effective treatment, the mortality rate in TB patients remains high. This study aimed to identify factors associated with mortality in TB patients receiving first-line treatment in Rwanda.

Methods: A retrospective cross-sectional study was conducted among adult TB patients aged 15 and above, including those engaged in first-line therapy and registered in health facilities' National electronic individual records (e-TB) between July 2019 and June 2022. Multivariate logistic regression analysis was used to identify significant independent variables retained in an unadjusted model.

Results: Of the 14,451 patients included in the study, 1,262 (8.7%) died during treatment. Death rates were higher in the cohorts of clinically diagnosed (17.1%), and TB/HIV co-infected (16.9%) Several factors were significantly associated with mortality. The risk was higher in patients who were underweight at initial treatment (aOR=1.78, 95% CI: 1.39-2.28), clinically diagnosed with TB (aOR=1.72, 95% CI: 1.27-2.34), not currently on ART (aOR=9.22, 95% CI: 6.39-13.29). Being managed in referral hospitals (aOR=2.58, 95% CI: 1.77-3.76) or district hospitals (aOR=2.18, 95% CI: 1.58-3.01), and not followed up by CHWs (aOR=2.68, 95% CI: 1.92-3.74). Interestingly, being an inmate was found to be a protective factor, with a lower risk of dying from TB compared to those who were not in prison (aOR=0.35, 95% CI: 0.16-0.78).

Conclusion: This study highlights the importance of early diagnosis and treatment of TB, as well as the need for comprehensive healthcare services and follow-up, particularly for patients who are underweight, being not on ART. Additionally, the study provides insight into the potential benefits of prison healthcare systems in managing TB. These findings could inform public health policies and interventions aimed at reducing mortality rates in TB patients in Rwanda and other similar settings.