Patients with tuberculosis in Bolivia: why do they die?

The objective of this research was to analyze why patients with tuberculosis (TB) die and to evaluate whether there are factors contributing to their fatal outcome that could be corrected. A cross-sectional observational study was conducted of the patients with active TB or its sequelae admitted to the TB ward of the main public hospital in the city of Santa Cruz, Bolivia, over a 29-month period, from October 1993 through February 1996. The available records of the patients who died during hospitalization were reviewed. Out of 597 patients, 94 of them (15.7%) died. We examined the records of 90 of these 94 patients. Their mean age was 35.1 years (standard deviation, 16.7 years), and 45 of the patients (50.0%) were male. On admission 42 of the 90 patients (46.7%) had never been treated for TB or had received anti-TB treatment for less than one month, 23 (25.6%) had returned after having abandoned their TB treatment, 8 (8.9%) had had an erroneous diagnosis, 6 (6.7%) had tuberculosis sequelae, 6 (6.7%) were undergoing tuberculosis treatment, and 5 (5.6%) were known to have multidrug-resistant TB. Of the 90 patients, 83 (92.2%) had pulmonary tuberculosis (median lobes affected, 4), 6 (6.7%) had pleural tuberculosis, and 12 (13.3%) had extrapulmonary tuberculosis (some patients had more than one form of TB). Patients died a median of 5.5 days after entering the TB ward. The causes of death were: hemoptysis, 6 patients (6.7%); other tuberculosis-related causes, 65 patients (72.2%); drug reactions, 6 patients (6.7%); nontuberculosis causes, 6 patients (6.7%); and undetermined causes, 7 patients (7.8%). Factors possibly contributing to death were late diagnosis (38.9%), errors in follow-up (14.4%), and errors in treatment (24.4%). In conclusion, most patients with active or inactive TB admitted to our ward died as a consequence of tuberculosis. There were several factors possibly contributing to their fatal outcome that could be corrected

Poor Quality of Data and Care Cast Doubts on Reported Success of Uganda's TB Programme: A study of the Unit Tuberculosis Registers of three Ugandan hospitals

With the global resurgence of TB as a public health threat especially in association with HIV-coinfection, accompanied by mismanagement which has led to the emergence of multi-drug resistant TB disease, it is important that care for patients and record-keeping be enhanced. The objective of this study was to analyze the recording of TB cases in Unit Tuberculosis Registers of three Ugandan hospitals in order to identify and quantify the deficiencies in the data registered, for improvement. The design was a retrospective study of the Unit Tuberculosis Registers, with interviews of the staff responsible for entering the data. The setting was three hospitals in the South-Eastern zone of the National Tuberculosis and Leprosy Programme of Uganda - St Francis Buluba Hospital in Mayuge District, Jinja Regional Referral Hospital in Jinja District and Iganga Hospital in Iganga District. All the patients records of cases of tuberculosis entered in the Unit Tuberculosis Registers during 2002 were analysed for the standard TB programme indicators. The Main outcome measures were errors, misclassifications and missing data for each patient registered. The study identified areas for intervention to improve data accuracy. Many so-called cases were diagnosed clinically and never confirmed by laboratory sputum smear examination. Most cases had pulmonary TB. Despite a highly-rated national TB programme, these key field sites showed a cure rate of only 13%, a treatment completion rate of 26% and a treatment-defaulter rate of 29%. These findings are much worse than the reported national figures at the time and suggest a need for the national level to strengthen lower levels further, in order to improve case management, follow-up and reporting