Tuberculosis mortality and the male survival deficit in rural South Africa: An observational community cohort study

Reniers, Georges; Blom, Sylvia; Lieber, Judith; Herbst, Abraham J; Calvert, Clara; Bor, Jacob; Bärnighausen, Till; Żaba, Basia; Li, Zehang R; Clark, Samuel J.; Grant, Alison D.; Lessells, Richard J; Eaton, Jeffrey W.; Hosegood, Victoria

doi:10.1371/journal.pone.0185692

Cited by 7 publications

(10 citation statements)

References 39 publications

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“…Mortality due to tuberculosis was statistically higher among males than females. Similar observations have been reported in South Africa [34]. Unlike in the present study, where more females died of pneumonia and PCP, in Nigeria, pulmonary TB, asthma, pneumonia and pleural pathologies were more common among women [23].…”

Section: Discussionsupporting

confidence: 90%

“…In this study, young adults accounted for the majority of deaths due to respiratory diseases; and females died at younger mean age than males. In a study in a tertiary hospital in Nigeria, respiratory diseases were predominant in the [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] year age bracket and among women [23]. In a recent analysis involving 23 countries in Africa, in-hospital respiratory mortality was reported to occur predominantly in very young individuals and those 18-49 years old [13].…”

Section: Discussionmentioning

confidence: 99%

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Trends, patterns and causes of respiratory disease mortality among inpatients in Tanzania, 2006–2015

Kishamawe

Rumisha

Mremi

et al. 2018

Tropical Med Int Health

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Objective To determine the causes, patterns and trends of respiratory diseases‐related deaths in hospitals of Tanzania 2006–2015. Methods Retrospective study involving 39 hospitals. Medical records of patients who died in hospital were retrieved, reviewed and analysed. Sources of data were hospital admission registers, death registers and International Classification of Diseases report forms. Information on demographic characteristics, date of death, the immediate underlying cause of death and co‐morbid conditions was collected. Results Of the 247 976 deaths reported during the 10‐year period, respiratory diseases accounted for 12.92% (n = 32 042). The majority of the respiratory mortality was reported among males (55.9%). Overall median age at death was 31 years with an interquartile range (IQR) of 1–47. Median age at death was significantly higher among males (35 years) than females (28 years) (P < 0.0001). Most deaths (37.8%) occurred in eastern Tanzania. About one‐third (31.3%) of all respiratory mortality was reported among under‐five children, being among girls than boys (34.3% vs. 28.9%, χ2 = 10.3, P < 0.0001). Adolescent and young adult females (15–29 years) had higher age‐standardised mortality rates per 100 000 due respiratory diseases than males. Pneumonia (n = 16 639; 51.9%) and pulmonary tuberculosis (n = 9687; 30.2%) accounted for the majority of deaths due to respiratory diseases. Significantly more females (n = 7665; 54.5%) than males died from pneumonia (n = 8878; 49.8%; χ2 = 8.5, P < 0.0001). By contrast, significantly more males (n = 6024; 34%) than females (n = 3596; 26%; χ2 = 15.5, P < 0.0001) died of tuberculosis. The proportion of death due to tuberculosis declined from 32.8% in 2006–2010 to 7.9% in 2011–2015. However, there was a significant increase in the proportion of death due to pneumonia from 49.6% in 2006–2010 to 53.4% in 2011–2015. Co‐morbid conditions contributed to 9.1% (2871/31 628) of all deaths due to respiratory diseases. The most common co‐morbid condition was HIV which accounted for 1735 (60.4%) deaths and was more common among males (60.8%; n = 957) than among females (59.7%; n = 764). Conclusions Respiratory diseases account for a substantial proportion of all causes of hospital death in Tanzania. Pneumonia and tuberculosis contribute to more than three quarters of all deaths due to respiratory diseases. Since most major respiratory illnesses are avoidable, it is important to strengthen the capacity of the health delivery system in managing cases of respiratory diseases.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Trends, patterns and causes of respiratory disease mortality among inpatients in Tanzania, 2006–2015

Kishamawe

Rumisha

Mremi

et al. 2018

Tropical Med Int Health

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“…In the present study, we observed an excess mortality among men after adjusting for several baseline characteristics, including CD4 cell count, that was concentrated among younger men. Collectively, these findings suggest that, at least in part, the mortality excess noted among men in sub-Saharan Africa is likely attributable to causes independent of HIV [24,65].…”

Section: Plos Medicinementioning

confidence: 86%

Mortality estimates by age and sex among persons living with HIV after ART initiation in Zambia using electronic medical records supplemented with tracing a sample of lost patients: A cohort study

et al. 2020

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Background Men in sub-Saharan Africa have lower engagement and retention in HIV services compared to women, which may result in differential survival. However, the true magnitude of difference in HIV-related mortality between men and women receiving antiretroviral therapy (ART) is incompletely characterized. Methods and findings We evaluated HIV-positive adults �18 years old newly initiating ART in 4 Zambian provinces (Eastern, Lusaka, Southern, and Western). In addition to mortality data obtained from routine electronic medical records, we intensively traced a random sample of patients lost to follow-up (LTFU) and incorporated tracing outcomes through inverse probability weights. Sex-specific mortality rates and rate differences were determined using Poisson regression. Parametric g-computation was used to estimate adjusted mortality rates by sex and age. The study included 49,129 adults newly initiated on ART between August 2013 and July 2015; overall, the median age among patients was 35 years, the median baseline CD4 count was 262 cells/μl, and 37.2% were men. Men comprised a smaller proportion of individuals starting ART (37.2% versus 62.8%), tended to be older (median age 37 versus 33 years), and tended to have lower CD4 counts (median 220 versus 289 cells/μl) at the time of

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“…In KwaZulu-Natal, exceptionally high levels of excess male mortality in young adults have been documented at different stages of the HIV epidemic. The causes of excess male mortality particularly in young men, is not only due to HIV/AIDS and TB deaths but also higher rates of road traffic accidents, intentional injuries and non-communicable diseases [ 20 , 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Trends in the prevalence and incidence of orphanhood in children and adolescents <20 years in rural KwaZulu-Natal South Africa, 2000-2014

et al. 2020

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Background In South Africa, large increases in early adult mortality during the 1990s and early 2000s have reversed since public HIV treatment rollout in 2004. In a rural population in KwaZulu-Natal, we investigate trends in parental mortality and orphanhood from 2000–2014. Methods Using longitudinal demographic surveillance data for a population of approximately 90,000, we calculated annual incidence and prevalence of maternal, paternal and double orphanhood in children and adolescents (<20 years) and, overall and cause-specific mortality of parents by age. Results The proportion of children and adolescents (<20 years) for whom one or both parents had died rose from 26% in 2000 to peak at 36% in 2010, followed by a decline to 32% in 2014. The burden of orphanhood remains high especially in the oldest age group: in 2014, 53% of adolescents 15–19 years had experienced the death of one or both parents. In all age groups and years, paternal orphan prevalence was three-five times higher than maternal orphan prevalence. Maternal and paternal orphan incidence peaked in 2005 at 17 and 27 per 1,000 person years respectively (<20 years) before declining by half through 2014. The leading cause of parental death throughout the period, HIV/AIDS and TB cause-specific mortality rates declined substantially in mothers and fathers from 2007 and 2009 respectively. Conclusions The survival of parents with children and adolescents <20 years has improved in tandem with earlier initiation and higher coverage of HIV treatment. However, comparatively high levels of parental deaths persist in this rural population in KwaZulu-Natal, particularly among fathers. Community-level surveillance to estimate levels of orphanhood remains important for monitoring and evaluation of targeted state welfare support for orphans and their guardians.

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Tuberculosis mortality and the male survival deficit in rural South Africa: An observational community cohort study

Cited by 7 publications

References 39 publications

Trends, patterns and causes of respiratory disease mortality among inpatients in Tanzania, 2006–2015

Trends, patterns and causes of respiratory disease mortality among inpatients in Tanzania, 2006–2015

Mortality estimates by age and sex among persons living with HIV after ART initiation in Zambia using electronic medical records supplemented with tracing a sample of lost patients: A cohort study

Trends in the prevalence and incidence of orphanhood in children and adolescents <20 years in rural KwaZulu-Natal South Africa, 2000-2014

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