Factors contributing to tuberculosis mortality among new tuberculosis patients in Zululand Health District

During the period ranging from 2011 to 2013, Zululand Health District reported tuberculosis (TB) related mortality cases above the WHO’s norm of 10 percent. This raised concerns because TB is curable even if the person is HIV positive. The overall performance of TB programme in South Africa concealed the actual problem of TB related mortality in the country and most particularly in Zululand Health District. The aim of the study was to examine factors contributing to TB mortality, and the extent of TB related mortality in Zululand Health District. A retrospective, descriptive study was conducted to review records of data on the electronic TB register at the district level in order to ascertain the relationship between TB mortality and the contributory factors associated with TB mortality. The TB data was analysed using descriptive and inferential statistics to test the null hypothesis at the significance level of p< 0.05. The study was limited to only new patients enrolled between the periods from the 1st January 2012 to the 31 December 2013. The study found that TB/HIV comorbidity was a main factor contributing to mortality among new TB patients. Eighty percent (80%) of all patients who died were HIV positive. Poor CD4 monitoring, delays or failure to initiate TB/HIV comorbid patients was one of the factors associated with mortality (p < 0.0001, OR 0.51) among this cohort of patients. Poor DOT support system significantly (p< 0.0008, OR 0.81) contributed to mortality in this district. The study also found significant association between mortality and failure to initiate comorbid patient on co-trimoxazole prophylaxis (Chi-square =9.1; df=1; p=0.0025). Tuberculosis and HIV comorbidity, and delays or failure to providing antiretroviral therapy to HIV positive patients were the main factors responsible for TB mortality in Zululand Health District. The whole phenomenon was attributable to health worker related factors. Good TB/HIV clinical management guidelines and protocols developed by the Department of Health, and distributed to all health facilities did not alleviate the problem. Support and supervision could translate policies and protocols to action