Factors Associated with Mortality in Smear Positive Pulmonary Tuberculosis, Huaiyot Hospital, Trang Province

Abstract

World Health Organization’s 2017 report estimated that Thailand would have 171 people suffer-ing from tuberculosis per 100,000 population; and approximately 12,000 people would die from tuber-culosis. The Ministry of Public Health has set a target to reduce case fatality rate to less than 5%. For Huaiyot Hospital, Trang Province, the mortality rate for tuberculosis patients was 5-8% per annum, which was higher than the target set by Ministry of Public Health. The objective of this study was to identify factors associated with mortality in smear positive TB patients in Huaiyot Hospital, Trang province. A retrospective case-control study among the patients registered during a 5-year period from the year 2556 to 2560. Data were collected from medical records, and were analyzed for mortality in smear positive pulmonary tuberculosis. The patient records were separated into 2 groups: the deaths and the survivors; and their characteristics and other related factors were compared by using Chi square or Fisher’s exact test. The factors with p-value less than 0.05 was used for further analysis using multivariate logistic regression.  It was found that, through reviewing the medical records of tuberculosis registry, 353 TB patients were successfully treated during the study period. Among them, 206 cases were smear positive TB, and 13 cases died. All dead cases were assigned to be the study group; and 52 survival cases were randomly selected to become the comparison group. Based on the analysis, factors found to be associated with TB mortality in patients with smear positive pulmonary tuberculosis were (1) the frequency of 2 to 3 times sputum smear positive detection, with 113 times risk ratio (p=0.003); (2) the age at or above 75 years, risk ratio of 34 (p=0.012); (3) the existing comorbidity (such as diabetes, AIDS, chronic lung disease, chronic liver cancer, bedridden old cerebrovascular accident), risk ratio of 19 (p=0.002); and (4) the body weight less than or equal to 45 kilograms, the risk ratio of 11 (p=0.014). Therefore, these factors should be closely monitors among all smear positive TB patients in order to reduce the mortality of tuberculosis.