title: High mortality and prevalence of HIV and tuberculosis in adults with chronic cough in Malawi: a cohort study.
abstract: BACKGROUND
  Adults with suspected tuberculosis (TB) in health facilities in Africa have a high risk of death. The risk of death for adults with suspected TB at community-level is not known but may also be high.
  
  
  METHODS
  Adults reporting cough of ⩾ 2 weeks (coughers) during a household census of 19,936 adults in a poor urban setting in Malawi were randomly sampled and age-frequency matched with adults without cough ⩾ 2 weeks (controls). At 12 months, participants were traced to establish vital status, offered human immunodeficiency virus (HIV) testing and investigated for TB if symptomatic (sputum for Xpert(®) MTB/RIF, smear microscopy and culture).
  
  
  RESULTS
  Of 345 individuals with cough, 245 (71%) were traced, as were 243/345 (70.4%) controls. TB was diagnosed in 8.9% (16/178) of the coughers and 3.7% (7/187) of the controls (P = 0.039). HIV prevalence among coughers was 34.6% (56/162) and 18.8% (32/170) in controls (P = 0.005); of those who were HIV-positive, respectively 26.8% and 18.8% were newly diagnosed. The 12-month risk of death was 4.1% (10/245) in coughers and 2.5% (6/243) in controls (P = 0.317).
  
  
  CONCLUSIONS
  Undiagnosed HIV and TB are common among adults with chronic cough, and mortality is high in this urban setting. Interventions that promote timely seeking of HIV and TB care are needed.
authors.affiliation: Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi.
authors.forename: M
authors.initials: M
authors.lastname: Nliwasa
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, UK; Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: P
authors.initials: P
authors.lastname: MacPherson
authors.affiliation: Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi; School of Public Health, College of Medicine, Blantyre, Malawi.
authors.forename: M
authors.initials: M
authors.lastname: Mukaka
authors.affiliation: Malawi-Liverpool-Wellcome Trust Research Programme, College of Medicine, Blantyre, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Mdolo
authors.affiliation: Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi.
authors.forename: M
authors.initials: M
authors.lastname: Mwapasa
authors.affiliation: Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi.
authors.forename: K
authors.initials: K
authors.lastname: Kaswaswa
authors.affiliation: Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi.
authors.forename: C
authors.initials: C
authors.lastname: Msefula
authors.affiliation: Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi.
authors.forename: G
authors.initials: G
authors.lastname: Chipungu
authors.affiliation: Malawi-Liverpool-Wellcome Trust Research Programme, College of Medicine, Blantyre, Malawi.
authors.forename: H C
authors.initials: HC
authors.lastname: Mwandumba
authors.affiliation: Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi; Malawi-Liverpool-Wellcome Trust Research Programme, College of Medicine, Blantyre, Malawi; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: E L
authors.initials: EL
authors.lastname: Corbett
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002908:Chronic Disease; D060085:Coinfection; D003371:Cough / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D006297:Health Services Accessibility; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult