A systematic review of risk factors for mortality among tuberculosis patients in South Africa

Background Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. Methods We conducted a systematic review of TB research articles published between 2010 and 2018. We searched BioMed Central (BMC), PubMed®, EBSCOhost, Cochrane, and SCOPUS for publications between January 2010 and December 2018. Searches were conducted between August 2019 and October 2019. We included randomised control trials (RCTs), case control, cross sectional, retrospective, and prospective cohort studies where TB mortality was a primary endpoint and effect measure estimates were provided for risk factors for TB mortality during TB treatment. Due to heterogeneity in effect measures and risk factors evaluated, a formal meta-analysis of risk factors for TB mortality was not appropriate. A random effects meta-analysis was used to estimate case fatality ratios (CFRs) for all studies and for specific subgroups so that these could be compared. Quality assessments were performed using the Newcastle-Ottawa scale or the Cochrane Risk of Bias Tool. Results We identified 1995 titles for screening, 24 publications met our inclusion criteria (one cross-sectional study, 2 RCTs, and 21 cohort studies). Twenty-two studies reported on adults (n = 12561) and two were restricted to children < 15 years of age (n = 696). The CFR estimated for all studies was 26.4% (CI 18.1–34.7, n = 13257 ); 37.5% (CI 24.8-50.3, n = 5149) for drug-resistant (DR) TB; 12.5% (CI 1.1–23.9, n = 1935) for drug-susceptible (DS) TB; 15.6% (CI 8.1–23.2, n = 6173) for studies in which drug susceptibility was mixed or not specified; 21.3% (CI 15.3-27.3, n = 7375) for people living with HIV/AIDS (PLHIV); 19.2% (CI 7.7–30.7, n = 1691) in HIV-negative TB patients; and 6.8% (CI 4.9–8.7, n = 696) in paediatric studies. The main risk factors associated with TB mortality were HIV infection, prior TB treatment, DR-TB, and lower body weight at TB diagnosis. Conclusions In South Africa, overall mortality during TB treatment remains high, people with DR-TB have an elevated risk of mortality during TB treatment and interventions to mitigate high mortality are needed. In addition, better prospective data on TB mortality are needed, especially amongst vulnerable sub-populations including young children, adolescents, pregnant women, and people with co-morbidities other than HIV. Limitations included a lack of prospective studies and RCTs and a high degree of heterogeneity in risk factors and comparator variables

'Sameness' and 'Difference' Revisited: Which Way Forward For Equal Opportunity Initiatives?

Recent interest in 'managing diversity' has reopened debates about forms of equality in the workplace. Approaches to equality developed in the 1970s and 1980s have been characterized as an attempt to ensure that if individuals bring the same abilities to work, or perform in the same way, they should receive the same access to jobs and employment benefits, regardless of social group membership. Managing diversity appears to be about a more positive valuing of difference. Benefits are seen to derive from different perspectives and approaches and these should be nurtured and rewarded rather than suppressed. Feminists have long argued about the extent to which women are the same as, or different from, men, and about the political consequences of adopting these positions. Recent theoretical developments have led to some novel solutions to this dilemma. These include asserting claims to both 'sameness' and 'difference', the deconstruction of 'difference', and the reconstruction of 'sameness' on women's terms. This paper explores approaches to equal opportunities through both established and novel theoretical perspectives. It argues that existing practice cannot be fitted neatly into the conventional distinctions between 'sameness' and 'difference', and explores the potential characteristics and strengths and weaknesses of equality initiatives based on the new theoretical perspectives. Copyright 1996 Basil Blackwell Ltd.