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Baluku JB, Namanda B, Namiiro S, Rwabwera DK, Mwesigwa G, Namaara C, Twinomugisha B, Nyirazihawe I, Nuwagira E, Kansiime G, Kizito E, Nabukenya-Mudiope MG, Sekadde MP, Bongomin F, Senfuka J, Olum R, Byaruhanga A, Munabi I, Kiguli S. Death after cure: mortality among pulmonary tuberculosis survivors in rural Uganda. Int J Infect Dis 2024:107069. [PMID: 38649006 DOI: 10.1016/j.ijid.2024.107069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE To determine the incidence of mortality and its predictors among pulmonary TB (PTB) survivors treated at a rural Ugandan tertiary hospital. METHODS We conducted a retrospective chart review of data between 2013 and 2023. We included all people that met the WHO's definition of tuberculosis cure and traced them or their next of kin to determine vital status (alive/deceased). We estimated the cumulative incidence of mortality per 1,000 population, crude all-cause mortality rate per 1,000 person-years, and median years of potential life lost (YPLL) for deceased individuals. Using Cox proportional hazard models, we investigated predictors of mortality. RESULTS Of 334 PTB survivors enrolled, 38 (11.4%) had died. The cumulative incidence of all-cause mortality was 113.7 per 1,000 population, and the crude all-cause mortality rate was 28.5 per 1,000 person-years. The median YPLL for deceased individuals was 23.8 years (IQR: 9.6-32.8). Hospitalization (aHR: 4.3, 95% CI: 1.1-16.6) and unemployment (aHR: 7.04, 95% CI: 1.5-31.6) at TB treatment initiation predicted mortality. CONCLUSION PTB survivors experience post high mortality rates after TB cure. Survivors who were hospitalized and unemployed at treatment initiation were more likely to die after cure. Social protection measures and long-term follow-up of previously hospitalized patients could improve the long-term survival of TB survivors.
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Affiliation(s)
- Joseph Baruch Baluku
- Makerere University Lung Institute, Kampala, Uganda; Kiruddu National Referral Hospital, Kampala, Uganda; Mbarara University of Science and Technology, Mbarara, Uganda.
| | | | | | | | | | | | | | | | - Edwin Nuwagira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Grace Kansiime
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Ronald Olum
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Ian Munabi
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah Kiguli
- Makerere University College of Health Sciences, Kampala, Uganda
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Baluku JB, Nakazibwe B, Twinomugisha B, Najjuuko R, Isabella N, Nassozi S, Namiiro S, Katagira W, Byonanebye DM, Sekaggya-Wiltshire C, Muchiri J, Ndungu E, Anguzu G, Mayanja-Kizza H, Andia-Biraro I. One dollar incentive improves tuberculosis treatment outcomes in programmatic settings in rural Uganda. Sci Rep 2021; 11:19346. [PMID: 34588552 PMCID: PMC8481464 DOI: 10.1038/s41598-021-98770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
The study aim was to determine the association of a one United States dollar (USD) dollar incentive and tuberculosis (TB) treatment outcomes among people with TB receiving treatment at a rural hospital in Uganda under programmatic settings. We conducted a quasi-experiment in which people with TB were randomised (1:1 ratio) to receive either a one USD incentive at months 0, 2, 5 and 6 (Dollar arm) or routine care (Routine arm). A second control group (Retrospective controls) consisted of participants who had a treatment outcome in the preceding 6 months. Treatment outcomes were compared between the intervention and control groups using Pearson’s chi-square and Fisher’s exact tests. The association between the incentive and treatment outcomes was determined using Poisson regression analysis with robust variances. Between November 2018 and October 2019, we enrolled 180 participants (60 in the Dollar arm and 120 in the Control group). TB cure (33.3% vs. 20.8%, p = 0.068) and treatment success (70.0% vs. 59.2% p = 0.156) were higher in the Dollar arm than the Control group, while loss-to-follow-up was lower in the Dollar arm (10.0% vs. 20.8% p = 0.070). Participants in the Dollar arm were more likely to be cured (adjusted incidence rate ratio (aIRR): 1.59, 95% CI 1.04–2.44, p = 0.032) and less likely to be lost to follow-up (aIRR: 0.44, 95% CI 0.20–0.96, p = 0.040). A one-dollar incentive was associated with higher TB cure and lower loss-to-follow-up among people with TB in rural Uganda.
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Affiliation(s)
- Joseph Baruch Baluku
- Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda. .,Makerere University Lung Institute, Kampala, Uganda. .,Directorate of Programs, Mildmay Uganda, Wakiso, PO Box 26343, Kampala, Uganda.
| | | | | | | | | | - Sylvia Nassozi
- Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | | | | | | | - Christine Sekaggya-Wiltshire
- Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda.,MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Joseph Muchiri
- Department of Community Health, School of Public health, Mount Kenya University, Thika, Kenya
| | - Elizabeth Ndungu
- Department of Community Health Nursing, Mount Kenya University, Thika, Kenya
| | - Godwin Anguzu
- Makerere University Infectious Disease Institute, Kampala, Uganda
| | | | - Irene Andia-Biraro
- Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda.,MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, Faculty of Infectious and Tropical Disease (ITD), London School of Hygiene and Tropical Medicine, London, UK
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