Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key
The goal of reducing tuberculosis (TB) mortality in the END TB Strategy can be achieved if TB deaths are considered predictable and preventable. This will require programs to examine and address some key gaps in the understanding of the distribution and determinants of TB mortality and the current m...
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doaj-40f3a5efde994fd396d3d4f358881f092020-11-25T02:59:24ZengElsevierJournal of Clinical Tuberculosis and Other Mycobacterial Diseases2405-57942020-05-0119Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the keyAnurag Bhargava0Madhavi Bhargava1Department of Medicine, Yenepoya Medical College, University Road, Deralakatte, Mangalore, 575018, India; Department of Medicine, McGill University, 1001 Decarie Boulevard, suite D05-2212, Mail Drop Number: D05-2214, Montreal, H4A 3J1, Canada; Center for Nutrition Studies, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore. 575018, India; Corresponding author at: Department of Medicine, Yenepoya Medical College, University Road, Deralakatte, Mangalore, 575018, India.Department of Community Medicine, Yenepoya Medical College, University Road, Deralakatte, Mangalore. 575018, India; Center for Nutrition Studies, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore. 575018, IndiaThe goal of reducing tuberculosis (TB) mortality in the END TB Strategy can be achieved if TB deaths are considered predictable and preventable. This will require programs to examine and address some key gaps in the understanding of the distribution and determinants of TB mortality and the current model of assessment and care in high burden countries.Most deaths in high-burden countries occur in the first eight weeks of treatment and in those belonging to the age group of 15–49 years, living in poverty, with HIV infection and/or low body mass index (BMI). Deaths result from extensive disease, comorbidities like advanced HIV disease complicated with other infections (bacterial, fungal, bloodstream), and moderate-severe undernutrition. Most early deaths in patients with TB, even with TB-HIV co-infection, are due to TB itself.Comprehensive assessment and clinical care are a prerequisite of patient-centered care. Simple independent predictors of death like unstable vital signs, BMI, mid-upper arm circumference, or inability to stand or walk unaided can be used by programs for risk assessment. Programs need to define criteria for referral for inpatient care, address the paucity of hospital beds and develop and implement guidelines for the clinical management of seriously ill patients with TB, advanced HIV disease and severe undernutrition as co-morbidities. Programs should also consider notification and audit of all TB deaths, similar to audit of maternal deaths, and address the issues in delays in diagnosis, treatment, and quality of care.http://www.sciencedirect.com/science/article/pii/S2405579420300139Clinical careCo-morbidityEnd-tb strategyEpidemiologyTb mortalitytuberculosis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Anurag Bhargava Madhavi Bhargava |
spellingShingle |
Anurag Bhargava Madhavi Bhargava Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Clinical care Co-morbidity End-tb strategy Epidemiology Tb mortality tuberculosis |
author_facet |
Anurag Bhargava Madhavi Bhargava |
author_sort |
Anurag Bhargava |
title |
Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key |
title_short |
Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key |
title_full |
Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key |
title_fullStr |
Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key |
title_full_unstemmed |
Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key |
title_sort |
tuberculosis deaths are predictable and preventable: comprehensive assessment and clinical care is the key |
publisher |
Elsevier |
series |
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases |
issn |
2405-5794 |
publishDate |
2020-05-01 |
description |
The goal of reducing tuberculosis (TB) mortality in the END TB Strategy can be achieved if TB deaths are considered predictable and preventable. This will require programs to examine and address some key gaps in the understanding of the distribution and determinants of TB mortality and the current model of assessment and care in high burden countries.Most deaths in high-burden countries occur in the first eight weeks of treatment and in those belonging to the age group of 15–49 years, living in poverty, with HIV infection and/or low body mass index (BMI). Deaths result from extensive disease, comorbidities like advanced HIV disease complicated with other infections (bacterial, fungal, bloodstream), and moderate-severe undernutrition. Most early deaths in patients with TB, even with TB-HIV co-infection, are due to TB itself.Comprehensive assessment and clinical care are a prerequisite of patient-centered care. Simple independent predictors of death like unstable vital signs, BMI, mid-upper arm circumference, or inability to stand or walk unaided can be used by programs for risk assessment. Programs need to define criteria for referral for inpatient care, address the paucity of hospital beds and develop and implement guidelines for the clinical management of seriously ill patients with TB, advanced HIV disease and severe undernutrition as co-morbidities. Programs should also consider notification and audit of all TB deaths, similar to audit of maternal deaths, and address the issues in delays in diagnosis, treatment, and quality of care. |
topic |
Clinical care Co-morbidity End-tb strategy Epidemiology Tb mortality tuberculosis |
url |
http://www.sciencedirect.com/science/article/pii/S2405579420300139 |
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