Tuberculosis (TB) is an infectious and chronic endemo-epidemic disease with human-to-human transmission through the respiratory tract with the organism Mycobacterium tuberculosis. It is a global public health issue, mainly in developing countries. According to the World Health Organization (WHO), the number of people infected with TB was around 10 million in 2018 [1] [2]. The annual incidence of tuberculosis varies widely from one country to another, ranging from less than 5 to 500 cases per 100,000 per year with an average of around 130 cases per 100,000 per year [2]. TB is among the top 10 causes of death in the world and the leading cause of death from a single infectious agent ranking above HIV/AIDS. In 2018 the number of people dying from TB was estimated at 1.2 million in those who are HIV negative and 251,000 in those co-infected with HIV. More than 95% of these deaths occur in medium or low-income countries [1] [2]. To deal with the high morbidity and mortality of TB, the WHO has adopted a response plan called “End TB” with the aims to reduce the incidence by 80% and death rate by 90% by the year 2030 [3]. Senegal is engaged in this strategy in the fight against this global public health issue. A National Health Plan against Tuberculosis (NHPT) was set up to reduce the morbi-mortality rate of TB. In this practical approach, the Senegalese authorities have created centers for early diagnose and treatment of TB to ensure testing and treatment of TB according to the national guidelines. Despite these important measures, in 2017, the NHPT reported an incidence of 122 new cases per 100,000. All categories of TB were included with a testing rate of 60% and a mortality rate up to 18 deaths per 100,000 [4]. Studies focusing on associated factors of deaths among patients infected with TB in Senegal are not very common, and they often deal with retrospective data and particular groups, such as HIV patients [5]. These are some of the reasons why we conducted this study to assess the different factors associated with death among patients infected with TB in two health care centers in Dakar.

During the study period, 282 patients infected with TB, all categories of TB, were enrolled and followed in the Department of Infectious and Tropical Diseases at FANN (57%), the Department of Infectious and Tropical Diseases at Dakar Principal Hospital (31%) and in the Department of Pulmonology at Dakar Principal Hospital (12%). There were 181 (64.2%) in-patients.

During a one-year period, we followed 282 TB patients in three TB treatment centers in Dakar, which are in accordance with the national TB guidelines. The mortality rate was 7.8%. All the potential explaining variables that were within our reach were taken into account in our analysis. Factors identified to be significantly associated with death after a multivariate analysis was: advanced age, HIV positive status, neurological localization of the TB, and severe anemia.

This prospective study shows a lower mortality rate than what was recently estimated in Africa and Senegal. It also presents a number of factors, such as advanced age, HIV infection status, neurological localization of TB, and severe anemia that increase mortality rate among TB patients. Knowledge of these associated factors by physicians could improve the management of TB patients and reduce TB-related mortality. This may contribute to reaching the goals of “End TB” strategy by 2030.

We would like to acknowledge:

· Moustapha Diop, English Professor (Cass Cass high school, Senegal) for the language edits;

· Jiyeon Jeon, MD, MPH (Providence Seaside Hospital, OR, USA) for the language and technical edits.

The authors declare no conflicts of interest regarding the publication of this paper.

Diop, M., Ba, P.S., Tine, J.A.D., Fall, N.M., Youbong, T., Ndiaye, M., Mbaye, N.M., Diatta, M.B.N., Sarr, A., Ndiaye, S.W., Cisse, I., Degenonvo, L.F., Niang, A., Faye, A. and Seydi, M. (2021) Factors Associated with Death among Tuberculosis Patients in Dakar. Advances in Infectious Diseases, 11, 122-139. https://doi.org/10.4236/aid.2021.112013

CRF

1) SOCIO-DEMOGRAPHIC DATA

Patient Code: |___|___|___|___|___|___| Day of admission: |___|___|___

In-patient: Yes q No q

Department: DITD*/DPH** q DITD/FANN HOSPITAL q

PULMONOLOGY/DPH q

Initial of first Name |___|___|___| Initial of second Name |___|___|___|

Address: __________________________________________________________

Sex: _____ Age: |___|___| years

Profession: ________________________________

Marital status: Single q Married q Divorced q Widowed q

School attendance: Yes q No q

Educational level: Primary q Secondary q University q

2) BACKGROUNDS-LIFESTYLE

➢ Backgrounds

TB contact: Yes q No q History of TB: Yes q No q

High blood pressure: Yes q No q Diabetes: Yes q No q

HIV: Yes q No q Others: Yes q No q if others, precise: _____

➢ Lifestyle

Alcohol consumption: Yes q No q

Smoking: No q Former smoker q current smoker q

3) CLINICAL DATA

➢ Functional signs:

The beginning of symptoms: |___|___|___| (days or months)

Coughing: Yes q No q Chest pain: Yes q No q

Dyspnea: Yes q No q Vomiting: Yes q No q

Headaches: Yes q No q Hemoptysis: Yes q No q

Others: Yes q No q If others, precise__________________

➢ Vital signs:

Temperature: |___|___|.|___| Weight: |___|___|___| kg Size: |___|.|___|___| m

Blood Pressure: |___|___|___|/|___|___|___| mm Hg

Respiratory rate: |___|___|___| c/min

Pulse: |___|___|___|

➢ General signs:

Long term fiver: Yes q No q

Weight loss: Yes q No q

Weakness: Yes q No q

Loss of appetite: Yes q No q

➢ Examination:

pulmonary condensation: Yes q No q

lymphadenopathy: Yes q No q if yes, Localization: ___________________

Pleurisy: Yes q No q

Pneumothorax: Yes q No q

meningeal syndrome: Yes q No q

Other neurological signs: Yes q No q if yes, precise: _____________

Ascites: Yes q No q

Other signs: Yes q No q If yes, precise: _____________________

4) PARACLINICAL INVESTIGATIONS

➢ Bacteriological investigations

Smear microscopy done: Yes q No q

Results of Smear microscopy: positive q Negative q

Specimen: Gastric lavage: Yes q No q

Smear: Yes q No q

Urines: Yes q No q

Lymph node puncture: Yes q No q

Broncho-alveolar lavage fluid: Yes q No q

Others: Yes q No q

If yes, precise________________

Gen Xpert done: Yes q No q

Results: positive q negative q

Specimen: Gastric lavage: Yes q No q

Smear: Yes q No q

Urines: Yes q No q

Lymph node puncture: Yes q No q

Broncho-alveolar lavage fluid: Yes q No q

Others: Yes q No q

If yes, precise________________

➢ Cells blood Count

Hemoglobin rate: |___|___|.|___| g/dl

Mean corpuscular volume: |___|___|___|.|___|fl

White blood cells: |___|___|___|___|___|/mm³

Red blood cells: |___|___|___|___|___|/mm³

Platelets: |___|___|___|___|___|___|/ml

Lymphocytes: |___|___|___|___|___|/mm³

Neutrophils: |___|___|___|___|___|/µL

➢ Blood biochemistry

AST: |___|___|___|. |___| IU/l ALT: |___|___|___|. |___| IU/l

Bili_T: |___|___|___|. |___| UI/l Bili_C: |___|___|___|. |___| UI/l

PAL: |___|___|___|. |___| UI/l Gamma_GT: |___|___|___|. |___| UI/l

Serum creatinine level: |___|___|___|. |___| mg/l, Azotemia: |___|.|___| g/l

Capillary blood sugar: |___|.|___| g/l, Natremia |___|___|___|.|___| Kaliemia|___|.|___|

CD4 count: |___|___|___|___| CRP: |___|___|___|. |___|

➢ Chest X-ray: Normal q Abnormal q Not done q

Precise abnormalities: alveolar sd q interstitial sd q alveolointertitial sd q pleural infusion q

miliary q cavitation q

pneumothorax q lymphadenopathies q other signs q, precise___

➢ Chest CT scan: Normal q Abnormal q Not done q

Precise abnormalities: alveolar sd q interstitial sd q alveolointertitial sd q

pleural infusion q miliary q cavitation q

pneumothorax q lymphadenopathies q

other signs q if yes, precise _____________

➢ Abdominal CT scan: Normal q Abnormal q Not done q

Precise abnormalities: Lymphadenopathy q Ascites q

Other signs: q, If other signs Precise: _______________________

5) TB CLASSIFICATIONS

Final diagnosis: New case q relapse case q treatment re-starting case q

TB categories: IPT q IET q Pulmonary + extrapulmonary TB q

Extrapulmonary localizations:

pleural q splenic q

pericardial q peritoneal q

lymph node q neurological q

articular bone q urogenital tract q

hepatic q

Other localizations q if other localizations, precise________

Confirmed TB: Yes q No q

If yes: by microcopy q by Gen Xpert q by culture q

6) TREATMENT DATA

• Anti-TB drugs:

Date de of starting: |___|___|/|___|___|/|___|___|___|___|

Treatment regimen: _________________

Number of tablets: |___|

• OTHER TREATMENT: __________________________________________________________________

7) EVOLUTION DATA

Hospital stay days: |___|___|___| (days)

Control after one month of treatment (M1)

Smear microcopy: Done q Not done q. Results: Positive q Negative q

Control after 5 month of treatment

Smear microcopy: Done q Not done q. Results: Positive q Negative q

Treatment outcomes: Success q Failure q loss of follow-up q Dead q

Transferred q

__________________________________________________________________

*Department of Infectious and Tropical Diseases

**Dakar Principal Hospital