Characteristics and Factors Associated with Mortality of New Pulmonary Tuberculosis Patients, Phang Nga Province, Fiscal Year 2017-2021

Abstract

Tuberculosis (TB) is a contagious disease that remains a public health problem in Thailand and around the globe. In 2021, the World Health Organization (WHO) ranked Thailand among countries with a high burden of TB, including TB associated with HIV infection. Thailand's Tuberculosis Strategic Plan (2017 - 2021) aims to reduce mortality by 95%, focusing on promoting research and development of innovations in prevention, treatment and control of TB so as to reduce the incidence by 12.5% per year. This study aimed to 1) examine epidemiological characteristics of new pulmonary tuberculosis patients in Phang Nga Province and 2) analyze factors associated with mortality among new pulmonary tuberculosis patients in Phang Nga Province. This research was a retrospective study: Case Control. A total of 440 study subjects   were randomly selected from all completed treatment tuberculosis patients which registered in hospitals in the Phang Nga province between 1 October 2017 and 30 September 2021 from the NTIP Thailand program of the Phang Nga Provincial Public Health Office. Most of the subjects were male (73.2%), over 50 years old (35%), bacterial concentration was high (≥2+) (84.5%), HIV-infected (7.3%). found that HIV was not received antiretroviral therapy (65.6%), had other comorbidities (25.2%). The most common comorbidities were emphysema (30.6%), followed by diabetes (28.8%) and liver disease (12.6%), respectively. Most of the subjects were male (73.2%), over 50 years old (35%), bacterial concentration was high (≥ 2+) (84.5%), HIV-infected (7.3%). found that HIV was not received antiretroviral therapy (65.6%), had other comorbidities (25.2%). The most common comorbidities were emphysema (30.6%), followed by diabetes (28.8%) and liver disease (12.6%), respectively. Factors statistically (P-value < 0.05) associated with death of new pulmonary tuberculosis patients in Phang Nga province by Multivariate logistic regression analysis included patients aged 50 years and over (aOR = 0.12, 95% CI 0.07-0.20, P-value < 0.01), Body Mass Index < 18.5 kg/m2 (aOR = 2.15, 95% CI 1.32–3.49, P-value < 0.01), Emphysema (aOR = 14.81, 95% CI 5.97-36.80, P-value < 0.01 and liver disease (aOR = 13.512, 95% CI 3.190-57.24, P-value < 0.01). Conclusion and Recommendation: Tuberculosis patients aged 50 years and over, body mass index (< 18.5 kg/m2), emphysema and liver disease comorbidities were at high risk of death. Therefore, patients with these risk factors must be closely monitored and consider hospitalization, especially during the first 1 - 2 months of TB treatment.