Causes and Determinant Factors of Death among Tuberculosis Patients during Treatment in Khonkaen Province, Fiscal Year 2009 -2010

Abstract

In Khonkaen province, Tuberculosis (TB) patients is increasing every year. But, the tendency of the success rate of TB treatment is decreasing, and below the target. The TB patients’ death is one of important causes. This unmatched case- control study aimed to study causes of death among TB patients in Khonkaen province. The subjects were all TB patients registered during the fiscal year 2009-2010. Those were treated in 2 hospitals with high mortality rate, which are the central hospital (Khonkaen Hospital) and community hospital (Namphong Community Hospital). Cases were 42 TB patients who died during treatment, and Controls were 200 TB patients who survived during treatment.The case record form that created by Bureau of Tuberculosis and 12 The Office of Disease Prevention and Control was used in Data collection. Descriptive statistics in the study were frequency, percentage, mean, and standard deviation. A multiple logistic regression analysis was then performed to compute adjusted odds ratios (ORadj) with 95% confidence intervals (significant level at 0.05).

     The results of TB patients’ death revealed that the ratio of male to female was 1:1.6. Median age of death was 61.5 years (minimum 24 years – maximum 85 years);those were married 78.6 percent, and unemployed 72.9 percent. Univariate analysis showed statistical significant associated risk factors with the TB patients mortality (p-value < 0.05) were the period during symptoms to start treatment ≥ 30 days (OR 0.40; 95% CI.0.19, 0.97; p=0.032), abnormal chest X-ray  (OR 0.39; 95% CI.0.19, 0.78; p=0.009), Comorbidity (OR 2.96; 95% CI.1.49, 5.89; p=0.002). Multivariate analysis final model showed statistical significant associated risk factors with the TB patients mortality were the period during symptoms to start treatment ≥ 30 days (OR 0.37; 95% CI.0.17, 0.79; p=0.011), Sputum AFB positive / not examined at the end of initial TB treatment  (OR 20.74; 95% CI.8.21, 52.36; p<0.001), Comorbidity (OR 4.42; 95% CI.1.70, 11.48; p=0.002).

     Results from this study suggest that administrators and service providers should recognize and have special care (patient-centered approach) for elderly patients, Sputum AFB positive/ not examined at the end of initial TB treatment patients and comorbidity patients. There should be an investigation of TB patients’ death to prevent and solve the problems. These can reduce mortality, and increase TB treatment success rate finally.