Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable?

Compares treatment outcomes among people initiated on first-line anti-TB treatment in relation to age

Abstract

Setting

A high tuberculosis (TB) incidence, resource-limited urban setting in Zimbabwe.

Objectives

To compare treatment outcomes among people initiated on first-line anti-tuberculosis treatment in relation to age and other explanatory factors.

Design

This was a retrospective record review of routine programme data. Results: Of 2209 patients included in the study, 133 (6%) were children (aged <10 years), 132 (6%) adolescents (10–19 years), 1782 (81%) adults (20–59 years) and 162 (7%) were aged 60 years, defined as elderly. The highest proportion of smear-negative pulmonary TB cases was among the elderly (40%). Unfavourable outcomes, mainly deaths, increased proportionately with age, and were highest among the elderly (adjusted relative risk 3.8, 95%CI 1.3–10.7). Having previous TB, being human immunodeficiency virus positive and not on antiretroviral treatment or cotrimoxazole preventive therapy were associated with an increased risk of unfavourable outcomes.

Conclusion

The elderly had the worst outcomes among all the age groups. This may be related to immunosuppressant comorbidities or other age-related diseases misclassified as TB, as a significant proportion were smear-negative. Older persons need better adapted TB management and more sensitive diagnostic tools, such as Xpert® MTB/RIF.

This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)

Citation

Ncube RT, Takarinda KC, Zishiri C, van den Boogaard W, Mlilo N, Chiteve C, Siziba N, Trinchán F, Sandy C. Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable? Public Health Action. 2017;7(3):212–7.

Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable?

Published 21 September 2017