The timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South India

This was a retrospective study in 16 selected Designated Microscopy Centres (DMCs) in Hyderabad, Krishna and Adilabad districts of Andhra Pradesh, South India. A review was performed of treatment cards and medical records of all TB patients (adults and children) registered and placed on standardized anti-tuberculosis treatment from January 2005 to September 2009.There were 8,240 TB patients (5183 males) of whom 492 (6%) were known to have died during treatment. Case-fatality was higher in those previously treated (12%) and lower in those with extra-pulmonary TB (2%). There was an even distribution of deaths during anti-tuberculosis treatment, with 28% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with "early death".In this large cohort of TB patients, deaths occurred with an even frequency throughout anti-TB treatment. Reasons may relate to i) the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii) co-morbidities, such as HIV/AIDS and diabetes mellitus, which are known to influence mortality. More research in this area from prospective and retrospective studies is needed.National TB Control Programmes (NTPs) routinely report treatment outcomes for patients with tuberculosis (TB). This is reflected in national reports and also annual reports from the World Health Organization (WHO) which provide data on treatment outcomes of TB patients from all countries in the world. Treatment outcomes include death, which is defined as death from any cause occurring during the course of anti-TB treatment.There have been a few publications on the timing of death in patients while on treatment. In sub-Saharan Africa, studies have shown that the majority of deaths occur early during the first 1-2 months of anti-tuberculosis treatment [1-3]. In sub-Saharan Africa, where co-infect