Predictors of tuberculosis death outcome: A survival analysis of tuberculosis patients notified

Objectives: Tuberculosis (TB) death remains a significant barrier to the “End TB strategy targets.” TB mortality rate in Kenya was 6% while Kathiani SC was 9.5% (2021). The study aimed to determine the survival rates and predictors of death among TB patients notified in Kathiani subcounty, Machakos, Kenya, between January 2021 and December 2023. Materials and Methods: A retrospective cohort study of TB patients notified in Kathiani Sub-County in January 2021 and December 2023 was conducted. Data were extracted from the treatment information from basic unit (TIBU) patient management system. Descriptive statistics were used to summarize participant characteristics. Survival probabilities were estimated using the Kaplan–Meier method, and differences between groups were assessed using the log-rank test. For multivariable analysis, a Cox proportional hazards model was fitted to identify predictors of TB-related death. Results: Out of 610 patients, 444 (73%) were male. Median age was 35 years (interquartile ranges: 27–45), TB/human immunodeficiency virus (HIV) co-infection was 120 (20%), pulmonary TB was 531 (87%), and bacteriologically confirmed 403 (66%). New TB cases were 481 (79%). Undernutrition (based on body mass index/Z-score) was 385 (63%), while 273 (46%) had comorbidities. Overall, 58 patients (9.8%) died during that period; the 6-month survival probability was 0.909. Multivariable analysis, significant predictors of death included HIV-positive status (adjusted hazard ratio [aHR] = 3.05; confidence interval [CI]: 1.78–5.21), presence of comorbidities (aHR = 2.82; CI: 1.40–5.71). Extra pulmonary TB patients exhibited lower survival probabilities (Log rank 8.32, p =0.0039). Conclusion: Risk of TB-related death remains high attributable to HIV infection, comorbidities, and type of TB. There is a need for integrated, patient-centered TB care, strengthened TB/HIV services, and improved management of chronic conditions (establish high-risk clinics, mentorship, enhanced community health education).