Tuberculosis treatment outcomes and associated factors with mortality of tuberculosis in Sanpatong Hospital, Chiang Mai Province, Thailand

Abstract

Tuberculosis (TB) is still the major public health problem in Thailand and around the world. In Sanpatong Hospital, the TB death rates during treatment each year were rising. This study aims to determine (1) the TB treatment outcomes, (2) the factors associated with death, and (3) the causes of death in TB patients. The 5-year secondary data were obtained from TB register (2014-2018) and were analyzed using cox regression model. The results revealed that 441 registered TB patients included had the average age of 54 years (range 40-67); the proportion of males was higher than females (2.53:1). The Majority of the patients (81.18%) achieved favorable treatment outcomes whereas 18.82%had unfavorable treatment outcomes. The main cause of unfavorable treatment outcomes was death (14.74%). Factors affecting death of TB patients after treatment were (1) patients infected with tuberculosis both in the pulmonary and extra-pulmonary, aHR 5.64 (95% CI 1.97-16.12) (2) patients with AFB 3+phlegm staining will have a greater chance of death than patients with negative sputum results, aHR 2.71 (95% CI1.32-5.56) (3) HIV-infected tuberculosis patients, aHR 2.67 (95%CI 1.28-5.58) (4) patients over 65 years of age, aHR 2.55 (95% CI 1.41-4.62) (5) patients at BMI <18.50 kg /m2, aHR 1.79 (95% CI 1.03-3.09). The main cause of death is from comorbidities and other infectious diseases rather than tuberculosis. The number of deaths peaked during the intensive phase of treatment in the first two months. Therefore, this important period should be more careful in order to control the comorbidities and to reduce the severity of the disease. Patients with complications and those with malnutrition should be considered as inpatient admission. Finally, it is important to promote early diagnosis and treatment measures to reduce tuberculosis cases and death rates in TB patients.