A systematic review of risk factors for mortality among tuberculosis patients in South Africa
Abstract Background Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. Methods We conducted a systematic review of TB research articles published between 201...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Systematic Reviews |
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| Online Access: | https://doi.org/10.1186/s13643-023-02175-8 |
| _version_ | 1797865443565764608 |
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| author | Tamaryn J Nicholson Graeme Hoddinott James A Seddon Mareli M Claassens Marieke M van der Zalm Elisa Lopez Peter Bock Judy Caldwell Dawood Da Costa Celeste de Vaal Rory Dunbar Karen Du Preez Anneke C Hesseling Kay Joseph Ebrahim Kriel Marian Loveday Florian M Marx Sue-Ann Meehan Susan Purchase Kogieleum Naidoo Lenny Naidoo Fadelah Solomon-Da Costa Rosa Sloot Muhammad Osman |
| author_facet | Tamaryn J Nicholson Graeme Hoddinott James A Seddon Mareli M Claassens Marieke M van der Zalm Elisa Lopez Peter Bock Judy Caldwell Dawood Da Costa Celeste de Vaal Rory Dunbar Karen Du Preez Anneke C Hesseling Kay Joseph Ebrahim Kriel Marian Loveday Florian M Marx Sue-Ann Meehan Susan Purchase Kogieleum Naidoo Lenny Naidoo Fadelah Solomon-Da Costa Rosa Sloot Muhammad Osman |
| author_sort | Tamaryn J Nicholson |
| collection | DOAJ |
| description | Abstract Background Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. Methods We conducted a systematic review of TB research articles published between 2010 and 2018. We searched BioMed Central (BMC), PubMed®, EBSCOhost, Cochrane, and SCOPUS for publications between January 2010 and December 2018. Searches were conducted between August 2019 and October 2019. We included randomised control trials (RCTs), case control, cross sectional, retrospective, and prospective cohort studies where TB mortality was a primary endpoint and effect measure estimates were provided for risk factors for TB mortality during TB treatment. Due to heterogeneity in effect measures and risk factors evaluated, a formal meta-analysis of risk factors for TB mortality was not appropriate. A random effects meta-analysis was used to estimate case fatality ratios (CFRs) for all studies and for specific subgroups so that these could be compared. Quality assessments were performed using the Newcastle-Ottawa scale or the Cochrane Risk of Bias Tool. Results We identified 1995 titles for screening, 24 publications met our inclusion criteria (one cross-sectional study, 2 RCTs, and 21 cohort studies). Twenty-two studies reported on adults (n = 12561) and two were restricted to children < 15 years of age (n = 696). The CFR estimated for all studies was 26.4% (CI 18.1–34.7, n = 13257 ); 37.5% (CI 24.8-50.3, n = 5149) for drug-resistant (DR) TB; 12.5% (CI 1.1–23.9, n = 1935) for drug-susceptible (DS) TB; 15.6% (CI 8.1–23.2, n = 6173) for studies in which drug susceptibility was mixed or not specified; 21.3% (CI 15.3-27.3, n = 7375) for people living with HIV/AIDS (PLHIV); 19.2% (CI 7.7–30.7, n = 1691) in HIV-negative TB patients; and 6.8% (CI 4.9–8.7, n = 696) in paediatric studies. The main risk factors associated with TB mortality were HIV infection, prior TB treatment, DR-TB, and lower body weight at TB diagnosis. Conclusions In South Africa, overall mortality during TB treatment remains high, people with DR-TB have an elevated risk of mortality during TB treatment and interventions to mitigate high mortality are needed. In addition, better prospective data on TB mortality are needed, especially amongst vulnerable sub-populations including young children, adolescents, pregnant women, and people with co-morbidities other than HIV. Limitations included a lack of prospective studies and RCTs and a high degree of heterogeneity in risk factors and comparator variables. Systematic review registration The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018108622. This study was funded by the Bill and Melinda Gates Foundation (Investment ID OPP1173131) via the South African TB Think Tank. |
| first_indexed | 2024-04-09T23:08:54Z |
| format | Article |
| id | doaj.art-f65b620844b240c0b835f918c3776e84 |
| institution | Directory Open Access Journal |
| issn | 2046-4053 |
| language | English |
| last_indexed | 2024-04-09T23:08:54Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Systematic Reviews |
| spelling | doaj.art-f65b620844b240c0b835f918c3776e842023-03-22T10:33:11ZengBMCSystematic Reviews2046-40532023-02-0112111610.1186/s13643-023-02175-8A systematic review of risk factors for mortality among tuberculosis patients in South AfricaTamaryn J Nicholson0Graeme Hoddinott1James A Seddon2Mareli M Claassens3Marieke M van der Zalm4Elisa Lopez5Peter Bock6Judy Caldwell7Dawood Da Costa8Celeste de Vaal9Rory Dunbar10Karen Du Preez11Anneke C Hesseling12Kay Joseph13Ebrahim Kriel14Marian Loveday15Florian M Marx16Sue-Ann Meehan17Susan Purchase18Kogieleum Naidoo19Lenny Naidoo20Fadelah Solomon-Da Costa21Rosa Sloot22Muhammad Osman23Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityCommunity Services and Health Directorate, City of Cape TownDivision of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg HospitalDivision of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape TownDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityCommunity Services and Health Directorate, City of Cape TownMetro Health Services, Southern and Western Substructure, Western Cape Government: HealthHIV and other Infectious Diseases Research Unit, South African Medical Research Council, KwaZulu-NatalDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityCentre for the AIDS Programme of Research in South Africa, CAPRISA-SA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-NatalCommunity Services and Health Directorate, City of Cape TownCommunity Services and Health Directorate, City of Cape TownDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityAbstract Background Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. Methods We conducted a systematic review of TB research articles published between 2010 and 2018. We searched BioMed Central (BMC), PubMed®, EBSCOhost, Cochrane, and SCOPUS for publications between January 2010 and December 2018. Searches were conducted between August 2019 and October 2019. We included randomised control trials (RCTs), case control, cross sectional, retrospective, and prospective cohort studies where TB mortality was a primary endpoint and effect measure estimates were provided for risk factors for TB mortality during TB treatment. Due to heterogeneity in effect measures and risk factors evaluated, a formal meta-analysis of risk factors for TB mortality was not appropriate. A random effects meta-analysis was used to estimate case fatality ratios (CFRs) for all studies and for specific subgroups so that these could be compared. Quality assessments were performed using the Newcastle-Ottawa scale or the Cochrane Risk of Bias Tool. Results We identified 1995 titles for screening, 24 publications met our inclusion criteria (one cross-sectional study, 2 RCTs, and 21 cohort studies). Twenty-two studies reported on adults (n = 12561) and two were restricted to children < 15 years of age (n = 696). The CFR estimated for all studies was 26.4% (CI 18.1–34.7, n = 13257 ); 37.5% (CI 24.8-50.3, n = 5149) for drug-resistant (DR) TB; 12.5% (CI 1.1–23.9, n = 1935) for drug-susceptible (DS) TB; 15.6% (CI 8.1–23.2, n = 6173) for studies in which drug susceptibility was mixed or not specified; 21.3% (CI 15.3-27.3, n = 7375) for people living with HIV/AIDS (PLHIV); 19.2% (CI 7.7–30.7, n = 1691) in HIV-negative TB patients; and 6.8% (CI 4.9–8.7, n = 696) in paediatric studies. The main risk factors associated with TB mortality were HIV infection, prior TB treatment, DR-TB, and lower body weight at TB diagnosis. Conclusions In South Africa, overall mortality during TB treatment remains high, people with DR-TB have an elevated risk of mortality during TB treatment and interventions to mitigate high mortality are needed. In addition, better prospective data on TB mortality are needed, especially amongst vulnerable sub-populations including young children, adolescents, pregnant women, and people with co-morbidities other than HIV. Limitations included a lack of prospective studies and RCTs and a high degree of heterogeneity in risk factors and comparator variables. Systematic review registration The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018108622. This study was funded by the Bill and Melinda Gates Foundation (Investment ID OPP1173131) via the South African TB Think Tank.https://doi.org/10.1186/s13643-023-02175-8TB mortalityCase fatalityRisk factorsSystematic reviewSouth Africa |
| spellingShingle | Tamaryn J Nicholson Graeme Hoddinott James A Seddon Mareli M Claassens Marieke M van der Zalm Elisa Lopez Peter Bock Judy Caldwell Dawood Da Costa Celeste de Vaal Rory Dunbar Karen Du Preez Anneke C Hesseling Kay Joseph Ebrahim Kriel Marian Loveday Florian M Marx Sue-Ann Meehan Susan Purchase Kogieleum Naidoo Lenny Naidoo Fadelah Solomon-Da Costa Rosa Sloot Muhammad Osman A systematic review of risk factors for mortality among tuberculosis patients in South Africa Systematic Reviews TB mortality Case fatality Risk factors Systematic review South Africa |
| title | A systematic review of risk factors for mortality among tuberculosis patients in South Africa |
| title_full | A systematic review of risk factors for mortality among tuberculosis patients in South Africa |
| title_fullStr | A systematic review of risk factors for mortality among tuberculosis patients in South Africa |
| title_full_unstemmed | A systematic review of risk factors for mortality among tuberculosis patients in South Africa |
| title_short | A systematic review of risk factors for mortality among tuberculosis patients in South Africa |
| title_sort | systematic review of risk factors for mortality among tuberculosis patients in south africa |
| topic | TB mortality Case fatality Risk factors Systematic review South Africa |
| url | https://doi.org/10.1186/s13643-023-02175-8 |
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