title: The timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South India.
abstract: BACKGROUND
  India has 2.0 million estimated tuberculosis (TB) cases per annum with an estimated 280,000 TB-related deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India:- i) treatment outcomes including the number who died while on treatment, ii) the month of death and iii) characteristics associated with "early" death, occurring in the initial 8 weeks of treatment.
  
  
  METHODS
  This was a retrospective study in 16 selected Designated Microscopy Centres (DMCs) in Hyderabad, Krishna and Adilabad districts of Andhra Pradesh, South India. A review was performed of treatment cards and medical records of all TB patients (adults and children) registered and placed on standardized anti-tuberculosis treatment from January 2005 to September 2009.
  
  
  RESULTS
  There were 8,240 TB patients (5183 males) of whom 492 (6%) were known to have died during treatment. Case-fatality was higher in those previously treated (12%) and lower in those with extra-pulmonary TB (2%). There was an even distribution of deaths during anti-tuberculosis treatment, with 28% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with "early death".
  
  
  CONCLUSIONS
  In this large cohort of TB patients, deaths occurred with an even frequency throughout anti-TB treatment. Reasons may relate to i) the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii) co-morbidities, such as HIV/AIDS and diabetes mellitus, which are known to influence mortality. More research in this area from prospective and retrospective studies is needed.
authors.affiliation: LEPRA India - Blue Peter Public Health & Research Centre, Near TEC Building, Cherlapally, Hyderabad 501301, Andhra Pradesh, India. subbanna@leprahealthinaction.in
authors.forename: Subbanna
authors.initials: S
authors.lastname: Jonnalagada
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.forename: Srinath
authors.initials: S
authors.lastname: Satyanarayana
authors.forename: Shailaja
authors.initials: S
authors.lastname: Tetali
authors.forename: G
authors.initials: G
authors.lastname: Keshav Chander
authors.forename: Srinivas
authors.initials: S
authors.lastname: Rao
authors.forename: Ranganadha
authors.initials: R
authors.lastname: Rao
authors.forename: Sundaresh
authors.initials: S
authors.lastname: Peri
authors.forename: Raghupathy
authors.initials: R
authors.lastname: Anchala
authors.forename: Nanda K
authors.initials: NK
authors.lastname: Kannuri
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000401:mortality*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents