title: High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study.
abstract: Tuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment. Prompt initiation of TB treatment and access to antiretroviral therapy (ART) remains vital to the success of TB control. We assessed time to mortality after treatment onset using data from a large treatment centre in Nigeria.
  
  
  
  We analysed a retrospective cohort of TB patients that commenced treatment between January 2010 and December 2014 in Aminu Kano Teaching Hospital. We estimated mortality rates per person-months at risk (pm). Cox proportional hazards model was used to determine risk factors for mortality.
  
  
  
  Among 1,424 patients with a median age of 36.6 years, 237 patients (16.6%) died after commencing TB treatment giving a mortality rate of 3.68 per 100 pm of treatment in this cohort. Most deaths occurred soon after treatment onset with a mortality rate of 37.6 per 100 pm in the 1stweek of treatment. Risk factors for death were being HIV-positive but not on anti-retroviral treatment (ART) (aHR 1.39(1 · 04-1 · 85)), residence outside the city (aHR 3 · 18(2.28-4.45)), previous TB treatment (aHR 3.48(2.54-4.77)), no microbiological confirmation (aHR 4.96(2.69-9.17)), having both pulmonary and extra-pulmonary TB (aHR 1.45(1.03-2.02), and referral from a non-programme linked clinic/centre (aHR 3.02(2.01-4.53)).
  
  
  
  We attribute early deaths in this relatively young cohort to delay in diagnosis and treatment of TB, inadequate treatment of drug-resistant TB, and poor ART access. Considerable expansion and improvement in quality of diagnosis and treatment services for TB and HIV are needed to achieve the sustainable development goal of reducing TB deaths by 95% by 2035.
authors.affiliation: Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.|Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Aishatu L
authors.initials: AL
authors.lastname: Adamu
authors.affiliation: Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.|Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Muktar A
authors.initials: MA
authors.lastname: Gadanya
authors.affiliation: Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.|Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Isa S
authors.initials: IS
authors.lastname: Abubakar
authors.affiliation: Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.|Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Abubakar M
authors.initials: AM
authors.lastname: Jibo
authors.affiliation: Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.|Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Musa M
authors.initials: MM
authors.lastname: Bello
authors.affiliation: Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.|Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Auwalu U
authors.initials: AU
authors.lastname: Gajida
authors.affiliation: Department of Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria.|Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Musa M
authors.initials: MM
authors.lastname: Babashani
authors.affiliation: Institute for Global Health, University College London, London, UK. i.abubakar@ucl.ac.uk.
authors.forename: Ibrahim
authors.identifier: 0000-0002-0370-1430
authors.initials: I
authors.lastname: Abubakar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Adults; Mortality; Nigeria; Retrospective cohort; Risk factors; Tuberculosis