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Very early mortality in patients starting antiretroviral treatment at primary health centres in rural Malawi
Author(s) -
Zachariah Rony,
Harries Katie,
Moses Massaquoi,
Manzi Marcel,
Line Arnould,
Mwagomba Beatrice,
Harries Anthony D.
Publication year - 2009
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2009.02291.x
Subject(s) - medicine , primary health care , developing country , antiretroviral therapy , antiretroviral treatment , rural area , rural health , human immunodeficiency virus (hiv) , environmental health , pediatrics , population , family medicine , economic growth , viral load , pathology , economics
Summary 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 in 10 individuals 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.