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Khundi, McEwen, MacPherson, Peter 
ORCID: https://orcid.org/0000-0002-0329-9613, Feasey, Helena R. A., Nzawa Soko, Rebeca, Nliwasa, Marriott, Corbett, Elizabeth L. and Carpenter, James R.
(2021)
'Clinical, health systems and neighbourhood determinants of tuberculosis case fatality in urban Blantyre, Malawi: a multilevel epidemiological analysis of enhanced surveillance data'. Epidemiology and Infection, Vol 149.
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clinical-health-systems-and-neighbourhood-determinants-of-tuberculosis-case-fatality-in-urban-blantyre-malawi-a-multilevel-epidemiological-analysis-of-enhanced-surveillance-data.pdf - Published Version Available under License Creative Commons Attribution. Download (649kB) | Preview |
Abstract
We investigated whether household to clinic distance was a risk factor for death on tuberculosis (TB) treatment in Malawi. Using enhanced TB surveillance data, we recorded all TB treatment initiations and outcomes between 2015 and 2018. Household locations were geolocated, and distances were measured by a straight line or shortest road network. We constructed Bayesian multi-level logistic regression models to investigate associations between distance and case fatality. A total of 479/4397 (10.9%) TB patients died. Greater distance was associated with higher (odds ratio (OR) 1.07 per kilometre (km) increase, 95% credible interval (CI) 0.99–1.16) odds of death in TB patients registered at the referral hospital, but not among TB patients registered at primary clinics (OR 0.98 per km increase, 95% CI 0.92–1.03). Age (OR 1.02 per year increase, 95% CI 1.01–1.02) and HIV-positive status (OR 2.21, 95% CI 1.73–2.85) were also associated with higher odds of death. Model estimates were similar for both distance measures. Distance was a risk factor for death among patients at the main referral hospital, likely due to delayed diagnosis and suboptimal healthcare access. To reduce mortality, targeted community TB screening interventions for TB disease and HIV, and expansion of novel sensitive diagnostic tests are required.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > WC 20 Research (General) WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW) |
| Digital Object Identifer (DOI): | https://doi.org/10.1017/S0950268821001862 |
| Depositing User: | Stacy Murtagh |
| Date Deposited: | 04 Oct 2021 15:12 |
| Last Modified: | 10 Feb 2022 10:48 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/19079 |
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