Patients with tuberculosis in Bolivia: why do they die?
¿Por qué mueren los pacientes con tuberculosis en Bolivia?
Rev. panam. salud pública; 8 (3), 2000
Publication year: 2000
The objective of this research was to analyze why patients with tuberculosis (TB) die and to evaluate whether there are factors contributing to their fatal outcome that could be corrected. A cross-sectional observational study was conducted of the patients with active TB or its sequelae admitted to the TB ward of the main public hospital in the city of Santa Cruz, Bolivia, over a 29-month period, from October 1993 through February 1996. The available records of the patients who died during hospitalization were reviewed. Out of 597 patients, 94 of them (15.7 por cent) died. We examined the records of 90 of these 94 patients. Their mean age was 35.1 years (standard deviation, 16.7 years), and 45 of the patients (50.0 por cent) were male. On admission 42 of the 90 patients (46.7 por cent) had never been treated for TB or had received anti-TB treatment for less than one month, 23 (25.6 por cent) had returned after having abandoned their TB treatment, 8 (8.9 por cent) had had an erroneous diagnosis, 6 (6.7 por cent) had tuberculosis sequelae, 6 (6.7 por cent) were undergoing tuberculosis treatment, and 5 (5.6 por cent) were known to have multidrug-resistant TB. Of the 90 patients, 83 (92.2 por cent) had pulmonary tuberculosis (median lobes affected, 4), 6 (6.7 por cent) had pleural tuberculosis, and 12 (13.3 por cent) had extrapulmonary tuberculosis (some patients had more than one form of TB). Patients died a median of 5.5 days after entering the TB ward.
The causes of death were:
hemoptysis, 6 patients (6.7 por cent); nontuberculosis causes, 6 patients (6.7 por cent); and undetermined causes, 7 patients (7.8 por cent). Factors possibly contributing to death were late diagnosis (38.9 por cent), errors in follow-up (14.4 por cent), and errors in treatment (24.4 por cent). In conclusion, most patients with active or inactive TB admitted to our ward died as a consequence of tuberculosis. There were several factors possibly contributing to their fatal outcome that could be corrected
El objetivo de esta investigación consistió en determinar por qué mueren los pacientes con tuberculosis (TBC) y si existen factores que contribuyen al desenlace fatal que
puedan ser modificados. Durante un período de 29 meses, de octubre de 1993 a febrero de 1996, se realizó un estudio observacional transversal de los pacientes con
TBC activa o secuelas ingresados en la planta de TBC del principal hospital público
de la ciudad de Santa Cruz, Bolivia. Se revisaron los registros hospitalarios de los pacientes que fallecieron durante la hospitalización. Fallecieron 94 de 597 pacientes
(15,7%) y se revisaron los registros hospitalarios de 90 de ellos. El promedio de edad
fue de 35,1 años (desviación estándar de 16,7) y 45 pacientes (50%) eran varones. En
el momento del ingreso, 42 de los 90 pacientes (46,7%) nunca habían recibido tratamiento antituberculoso, o bien solo lo habían recibido durante menos de un mes; 23
(25,6%) habían vuelto al hospital después de haber abandonado el tratamiento; 8
(8,9%) habían recibido un diagnóstico equivocado; 6 (6,7%) tenían secuelas de TBC;
otros 6 estaban recibiendo tratamiento antituberculoso, y 5 (5,6%) padecían TBC resistente a múltiples fármacos. De los 90 pacientes, 83 (92,2%) tenían TBC pulmonar (mediana de lóbulos afectados: 4); 6 (6,7%) TBC pleural, y 12 (13,3%) TBC extrapulmonar
(algunos pacientes presentaban más de una forma de TBC). El número mediano de
días transcurridos entre el ingreso en la planta de TBC y el fallecimiento fue de 5,5.