Very early mortality in patients starting antiretroviral treatment at primary health centres in rural Malawi


Zachariah, R; Harries, K; Moses, M; Manzi, M; Line, A; Mwagomba, B; Harries, AD; (2009) Very early mortality in patients starting antiretroviral treatment at primary health centres in rural Malawi. Tropical medicine & international health, 14 (7). pp. 713-721. ISSN 1360-2276 DOI: https://doi.org/10.1111/j.1365-3156.2009.02291.x

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Abstract

OBJECTVES To report on the cumulative proportion of deaths occurring within 3 months of starting antiretroviral treatment (ART) and to identify factors associated with such deaths, among adults at primary health centres in a rural district of Malawi. methods Retrospective cohort study: from June 2006 to April 2008, deaths occurring over a 3-month period were determined and risk factors examined. RESULTS A total of 2316 adults (706 men and 1610 women; median age 35 years) were included in the analysis and followed up for a total of 1588 person-years (PY); 277 (12%) people died, of whom 206 (74%) people died within 3 months of initiating ART (cumulative incidence: 13.0; 95% confidence interval: 11.3-14.8 per 100 PY of follow-up). Significant risk factors associated with early deaths included male sex, WHO stage 4 disease, oesophageal or persistent oral candidiasis and unexplained presumed or measured weight loss >10%. One in every 3 patients who either died or was lost to follow up had unexplained weight loss >10%, and survival in this group was significantly different from patients without this condition. CONCLUSIONS Seven of 10 patients who die after initiating ART at primary health centres die early. Specific groups of patients are at higher risk of such mortality and should receive priority attention, care and support.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 19497082
Web of Science ID: 267886000002
URI: http://researchonline.lshtm.ac.uk/id/eprint/5058

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