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Open Access Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable?

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Setting: A high tuberculosis (TB) incidence, resource-limited urban setting in Zimbabwe.

Objectives: To compare treatment outcomes among people initiated on first-line anti-tuberculosis treatment in relation to age and other explanatory factors.

Design: This was a retrospective record review of routine programme data.

Results: Of 2209 patients included in the study, 133 (6%) were children (aged <10 years), 132 (6%) adolescents (10–19 years), 1782 (81%) adults (20–59 years) and 162 (7%) were aged 60 years, defined as elderly. The highest proportion of smear-negative pulmonary TB cases was among the elderly (40%). Unfavourable outcomes, mainly deaths, increased proportionately with age, and were highest among the elderly (adjusted relative risk 3.8, 95%CI 1.3–10.7). Having previous TB, being human immunodeficiency virus positive and not on antiretroviral treatment or cotrimoxazole preventive therapy were associated with an increased risk of unfavourable outcomes.

Conclusion: The elderly had the worst outcomes among all the age groups. This may be related to immunosuppressant comorbidities or other age-related diseases mis-classified as TB, as a significant proportion were smear-negative. Older persons need better adapted TB management and more sensitive diagnostic tools, such as Xpert® MTB/RIF.
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Keywords: Bulawayo; SORT IT; elderly; operational research

Document Type: Research Article

Affiliations: 1: International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Harare, Zimbabwe 2: Centre for Operations Research, The Union, Paris, France, AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe 3: Operational Research Unit, Médecins Sans Frontières, Luxembourg City, Luxembourg 4: AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe 5: Bulawayo City Health Department, Bulawayo, Zimbabwe

Publication date: September 21, 2017

This article was made available online on August 16, 2017 as a Fast Track article with title: "Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable?".

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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