Tuberculosis Mortalities Among In-patients at a Tertiary Hospital in Zambia Between 2018 and 2019 - The Spectrum of Clinical Presentations

Abstract

Background: Tuberculosis (TB) has remained one of the most important public health diseases and a leading cause of mortality from a single infectious agent in the world. In-patient mortalities have remained relatively high despite massive investment towards TB elimination. This prompted us to undertake a TB mortality review aimed at understanding the spectrum of clinical presentations in TB mortalities among in-patients in a local hospital set up in Zambia. Methods: Files of 74 in-patient TB related mortalities that had occurred at Kitwe Teaching Hospital over a 12-month period between June 2018 and June 2019 were audited using a structured questionnaire. The data was analyzed using SPSS v 16.0 statistical software while descriptive statistics and cross tabulation was used to determine the frequencies and cross relationships among the variables followed by univariate logistic regression whose significance was set at a p-value of 0.05 and a 95 percent confidence interval. Variables that were found to be significant at univariate logistic regression were fitted into the multivariable logistic regression. Results: The audit revealed that 50 (67.6%) of the files were for male patients with a mean age of 39.2 ± 11.6 years. 60(80%) were HIV positive, 60(80%) resided in high-density residential areas. On presentation to hospital, the commonest symptoms included productive cough and fever [31(41.9%) and 30(40.5%) respectively]. HIV positive male patients were presenting in hyperdynamic state (mean pulse rate of 117.2 ± 32.4 per minute, p = .001) and HIV positive females presented with mean arterial pressure (72.3 ± 19.5 mmHg, p = .002). Other findings included signs of multi-organ involvement [hypoalbuminemia 9(12.2%), deranged renal function 8(10.8%) and deranged liver enzymes 9(12.2%)] before mortality occurred. Conclusion: The spectrum of clinical presentations among in-patients with TB in a tertiary hospital include the following; male gender, age younger than 50 years, being HIV positive, residing in a high-density residential area and presenting with unstable hemodynamics. There is a need to focus strategies targeted at strengthening early recognition of clinical instability among admitted TB patients for at-risk populations, including young to middle aged males who are HIV positive.