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Open Access High mortality and prevalence of HIV and tuberculosis in adults with chronic cough in Malawi: a cohort study

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BACKGROUND: Adults with suspected tuberculosis (TB) in health facilities in Africa have a high risk of death. The risk of death for adults with suspected TB at community-level is not known but may also be high.

METHODS: Adults reporting cough of 2 weeks (coughers) during a household census of 19 936 adults in a poor urban setting in Malawi were randomly sampled and age-frequency matched with adults without cough 2 weeks (controls). At 12 months, participants were traced to establish vital status, offered human immunodeficiency virus (HIV) testing and investigated for TB if symptomatic (sputum for Xpert® MTB/RIF, smear microscopy and culture).

RESULTS: Of 345 individuals with cough, 245 (71%) were traced, as were 243/345 (70.4%) controls. TB was diagnosed in 8.9% (16/178) of the coughers and 3.7% (7/187) of the controls (P = 0.039). HIV prevalence among coughers was 34.6% (56/162) and 18.8% (32/170) in controls (P = 0.005); of those who were HIV-positive, respectively 26.8% and 18.8% were newly diagnosed. The 12-month risk of death was 4.1% (10/245) in coughers and 2.5% (6/243) in controls (P = 0.317).

CONCLUSION: Undiagnosed HIV and TB are common among adults with chronic cough, and mortality is high in this urban setting. Interventions that promote timely seeking of HIV and TB care are needed.
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Keywords: epidemiology; human immunodeficiency virus; presumed TB; sub-Saharan Africa

Document Type: Research Article

Affiliations: 1: *Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi 2: Department of Public Health and Policy, University of Liverpool, Liverpool, Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK 3: *Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi, §School of Public Health, College of Medicine, Blantyre 4: Malawi-Liverpool-Wellcome Trust Research Programme, College of Medicine, Blantyre, Malawi 5: *Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi, Malawi-Liverpool-Wellcome Trust Research Programme, College of Medicine, Blantyre, Malawi, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK

Publication date: February 1, 2016

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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