Title: Study to Determine Relapse and Mortality Rates in Tuberculosis Cases and their Epidemiological Correlates: A Historical Cohort Study
Authors: Dr Atul Gupta, Dr Shavinder Singh, Dr Rajesh Isaac, Dr Deepshikha Kamra
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.76
Abstract
Background: India is the country with the highest burden of TB. The World Health Organization (WHO) statistics for 2015 give an estimated incidence figure of 2.2 million cases of TB for India out of a global incidence of 9.6 million. The estimated TB prevalence in India for 2015 is 2.5 million.
Aims and Objectives
1. To determine the median relapse rate and to identify risk factors associated with TB relapse
2. To determine the mortality rate and its epidemiological correlates.
Methodology: All the diagnosed cases of tuberculosis over the period from Jan 2000 to Dec 2013, in the field practice areas of the Department of Community Medicine were followed up at their residences. 278 cases could be interviewed at home, and details were obtained about 14 deaths. Their history after the completion of their last course of ATT was determined, along with relevant history of disease till date using a structured questionnaire. Those who could not be located or contacted after two visits were excluded from the study. Data was entered into a Epidata Entry database and analyzed by Epidata Analysis 2.2.2 and EpiInfo 3.5.4 software.
Statistical Analysis: The percentages were used to describe relapse rates. Survival analysis was used to determine median relapse rates.
Results: 278 treated patients were available for interview. Fourteen deaths occurred among cases. Out of total 292 tuberculosis cases, 36 cases relapsed.
Out of those relapsed cases, 30 were on DOTs and 6 were on Non-DOTs regimen, but the difference was not statistically significant (p=0.0723). Available data showed a high relapse rate of 12.3%, exceeding the acceptable norm of less than five percent. Males were twice at the risk of relapsing as compared to females and it was statistically significant (p=0.0099). Mortality in males was six times higher than females (p=0.0029). Mortality in cases who were on DOTs regimen was higher as compared to cases who were on the Non-DOTs regimen, but difference was not statistically significant (p=0.5602). An association was seen between chronic alcoholics and cases who relapsed for the first time (p=0. 0000). The association was also seen between smokers and cases who relapsed for the first time (p=0.0000).
Conclusions: This retrospective cohort study revealed high relapse rates, above the recommended levels. Relapse rates were marginally higher among patients on DOTs as compared to non DOTs therapy. Mortality was six times higher in males as compared to females. Mortality rate was higher among patents on DOTs therapy as compared to non DOTs therapy. Measures to improve the compliance of DOTs therapy are urgently needed.
