Tuberculosis case fatality in India: a systematic review and meta-analysis
Introduction The WHO End TB Strategy calls for a global reduction in the case fatality ratio (CFR) below 5%. India accounts for a third of global tuberculosis (TB) deaths. This systematic review estimated CFRs among Indian patients with TB both during and after treatment.Methods We systematically se...
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BMJ Publishing Group
2020-01-01
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| Series: | BMJ Global Health |
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| author | Madhukar Pai Srinath Satyanarayana Vaidehi Nafade Sophie Huddart Anita Svadzian |
| author_facet | Madhukar Pai Srinath Satyanarayana Vaidehi Nafade Sophie Huddart Anita Svadzian |
| author_sort | Madhukar Pai |
| collection | DOAJ |
| description | Introduction The WHO End TB Strategy calls for a global reduction in the case fatality ratio (CFR) below 5%. India accounts for a third of global tuberculosis (TB) deaths. This systematic review estimated CFRs among Indian patients with TB both during and after treatment.Methods We systematically searched Medline, Embase and Global Health for eligible studies published between 1 January 2006 and 8 January 2019, including both cohort studies and intervention study control arms that followed Indian patients with TB for fatality either during treatment or post-treatment. From relevant studies we extracted CFRs in addition to study demographics. Study quality was assessed using modified Scottish Intercollegiate Guidelines Network cohort criteria. Sufficiently homogenous studies were pooled using a random effect generalised linear mixed model. A meta-regression was performed to associate study characteristics with resulting CFRs.Results 218 relevant studies were identified, of which 211 provided treatment phase CFRs. Most patients (92.4%) were treated in the public sector. Quality concerns were identified in 74% of papers. We estimated a pooled treatment phase CFR of 5.16% (95% CI 4.20% to 6.34%) which fell to 3.78% (2.77% to 5.16%) when restricted to 52 high-quality studies. Treatment phase CFRs were higher for paediatric (n=27, 6.50% (2.65% to 10.36%)), drug-resistant (n=43, 14.06% (10.15% to 19.49%)) and HIV-infected (n=35, 10.91% (7.68% to 15.50%)) patients. Nineteen post-treatment CFR studies were too heterogeneous to pool except when restricting to three high-quality studies (2.69% (–0.79% to 6.18%)). Poor study quality (OR=2.27 (2.01 to 2.57)) and tertiary centres patients (OR=1.15 (1.03 to 1.28)) were significantly associated with increased treatment phase case fatality.Conclusions Case fatality is a critical measure of the quality of TB care. While India’s treatment CFRs are in line with WHO targets, several key patient groups remain understudied and most studies suffer from methodological issues. Increased high-quality reporting on patient outcomes will help improve the evidence base on this topic. |
| format | Article |
| id | doaj-art-b025b8cfb3864a52a98e6608fca7bffc |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-b025b8cfb3864a52a98e6608fca7bffc2025-08-20T02:33:47ZengBMJ Publishing GroupBMJ Global Health2059-79082020-01-015110.1136/bmjgh-2019-002080Tuberculosis case fatality in India: a systematic review and meta-analysisMadhukar Pai0Srinath Satyanarayana1Vaidehi Nafade2Sophie Huddart3Anita Svadzian4McGill International TB Centre, McGill University, Montreal, Quebec, CanadaInternational Union Against Tuberculosis and Lung Disease, Delhi, IndiaEpidemiology and Biostatistics, McGill University, Montreal, Québec, CanadaEpidemiology & Biostatistics, McGill University, Montreal, Quebec, CanadaEpidemiology & Biostats, McGill University, Montreal, Quebec, CanadaIntroduction The WHO End TB Strategy calls for a global reduction in the case fatality ratio (CFR) below 5%. India accounts for a third of global tuberculosis (TB) deaths. This systematic review estimated CFRs among Indian patients with TB both during and after treatment.Methods We systematically searched Medline, Embase and Global Health for eligible studies published between 1 January 2006 and 8 January 2019, including both cohort studies and intervention study control arms that followed Indian patients with TB for fatality either during treatment or post-treatment. From relevant studies we extracted CFRs in addition to study demographics. Study quality was assessed using modified Scottish Intercollegiate Guidelines Network cohort criteria. Sufficiently homogenous studies were pooled using a random effect generalised linear mixed model. A meta-regression was performed to associate study characteristics with resulting CFRs.Results 218 relevant studies were identified, of which 211 provided treatment phase CFRs. Most patients (92.4%) were treated in the public sector. Quality concerns were identified in 74% of papers. We estimated a pooled treatment phase CFR of 5.16% (95% CI 4.20% to 6.34%) which fell to 3.78% (2.77% to 5.16%) when restricted to 52 high-quality studies. Treatment phase CFRs were higher for paediatric (n=27, 6.50% (2.65% to 10.36%)), drug-resistant (n=43, 14.06% (10.15% to 19.49%)) and HIV-infected (n=35, 10.91% (7.68% to 15.50%)) patients. Nineteen post-treatment CFR studies were too heterogeneous to pool except when restricting to three high-quality studies (2.69% (–0.79% to 6.18%)). Poor study quality (OR=2.27 (2.01 to 2.57)) and tertiary centres patients (OR=1.15 (1.03 to 1.28)) were significantly associated with increased treatment phase case fatality.Conclusions Case fatality is a critical measure of the quality of TB care. While India’s treatment CFRs are in line with WHO targets, several key patient groups remain understudied and most studies suffer from methodological issues. Increased high-quality reporting on patient outcomes will help improve the evidence base on this topic.https://gh.bmj.com/content/5/1/e002080.full |
| spellingShingle | Madhukar Pai Srinath Satyanarayana Vaidehi Nafade Sophie Huddart Anita Svadzian Tuberculosis case fatality in India: a systematic review and meta-analysis BMJ Global Health |
| title | Tuberculosis case fatality in India: a systematic review and meta-analysis |
| title_full | Tuberculosis case fatality in India: a systematic review and meta-analysis |
| title_fullStr | Tuberculosis case fatality in India: a systematic review and meta-analysis |
| title_full_unstemmed | Tuberculosis case fatality in India: a systematic review and meta-analysis |
| title_short | Tuberculosis case fatality in India: a systematic review and meta-analysis |
| title_sort | tuberculosis case fatality in india a systematic review and meta analysis |
| url | https://gh.bmj.com/content/5/1/e002080.full |
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