Clinical, health systems and neighbourhood determinants of tuberculosis case fatality in urban Blantyre, Malawi: a multilevel epidemiological analysis of enhanced surveillance data

Khundi, M., MacPherson, P. , Feasey, H. R. A., Nzawa Soko, R., Nliwasa, M., Corbett, E. L. and Carpenter, J. R. (2021) Clinical, health systems and neighbourhood determinants of tuberculosis case fatality in urban Blantyre, Malawi: a multilevel epidemiological analysis of enhanced surveillance data. Epidemiology and Infection, 149, e198. (doi: 10.1017/S0950268821001862) (PMCID:PMC8414598)

Abstract

We investigated whether household to clinic distance was a risk factor for death on tuberculosis (TB) treatment in Malawi. Using enhanced TB surveillance data, we recorded all TB treatment initiations and outcomes between 2015 and 2018. Household locations were geolocated, and distances were measured by a straight line or shortest road network. We constructed Bayesian multi-level logistic regression models to investigate associations between distance and case fatality. A total of 479/4397 (10.9%) TB patients died. Greater distance was associated with higher (odds ratio (OR) 1.07 per kilometre (km) increase, 95% credible interval (CI) 0.99–1.16) odds of death in TB patients registered at the referral hospital, but not among TB patients registered at primary clinics (OR 0.98 per km increase, 95% CI 0.92–1.03). Age (OR 1.02 per year increase, 95% CI 1.01–1.02) and HIV-positive status (OR 2.21, 95% CI 1.73–2.85) were also associated with higher odds of death. Model estimates were similar for both distance measures. Distance was a risk factor for death among patients at the main referral hospital, likely due to delayed diagnosis and suboptimal healthcare access. To reduce mortality, targeted community TB screening interventions for TB disease and HIV, and expansion of novel sensitive diagnostic tests are required.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Khundi, M., MacPherson, P., Feasey, H. R. A., Nzawa Soko, R., Nliwasa, M., Corbett, E. L., and Carpenter, J. R.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Epidemiology and Infection
• Publisher: Cambridge University Press
• ISSN: 0950-2688
• ISSN (Online): 1469-4409
• Published Online: 02 September 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Epidemiology and Infection 149: e198
• Publisher Policy: Reproduced under a Creative Commons License