High Mortality & Prevalence of HIV & Tuberculosis in Adults with Chronic Cough in Malawi: A Cohort Study

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.

Below:  Care seeking for HIV and TB in Panels A and B

Full PDF article at:   http://goo.gl/nrTsqQ

By:  Nliwasa M1, MacPherson P2, Mukaka M3, Mdolo A4, Mwapasa M1, Kaswaswa K1, Msefula C1, Chipungu G1, Mwandumba HC4, Corbett EL5.

• 1Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi.
• 2Department of Public Health and Policy, University of Liverpool, Liverpool, UK; Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK.
• 3Helse Nord Tuberculosis Initiative, Department of Pathology, College of Medicine, Blantyre, Malawi; School of Public Health, College of Medicine, Blantyre, Malawi.
• 4Malawi-Liverpool-Wellcome Trust Research Programme, College of Medicine, Blantyre, Malawi.
• 5Helse 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.
• Int J Tuberc Lung Dis. 2016 Feb;20(2):202-10. doi: 10.5588/ijtld.15.0388. 

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