Extra-pulmonary tuberculosis: A retrospective study of patients in Accra, Ghana

• Published in: PloS one Vol. 14; no. 1; p. e0209650
• Main Authors: Ohene, Sally-Ann, Bakker, Mirjam I, Ojo, John, Toonstra, Ardon, Awudi, Doris, Klatser, Paul
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09.01.2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Analysis; Antitubercular Agents - therapeutic use; Biology and Life Sciences; Caustic soda; Central nervous system; Clinical outcomes; Clinics; Confidence intervals; Databases, Factual; Demographics; Diagnosis; Epidemiology; Female; Ghana - epidemiology; Health care facilities; Health facilities; Health risks; HIV; Hospital facilities; Human immunodeficiency virus; Humans; Lymphatic system; Male; Medical diagnosis; Medical records; Medicine and Health Sciences; Microscopy; Middle Aged; Mortality; Patient outcomes; Patients; People and Places; Pleura; Population; Prevalence; Prognosis; Public health; Pulmonary tuberculosis; Regression analysis; Retrospective Studies; Risk analysis; Risk Factors; Sex Factors; Spine; Statistical analysis; Studies; Survival Rate; Treatment Outcome; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - mortality; Young Adult; Ghana; Netherlands; Nigeria; Ethiopia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0209650

Information on extrapulmonary TB (EPTB) patients is limited in many African countries including Ghana. The study objective was to describe the epidemiology of EPTB patients diagnosed from different categories of health facilities in Accra, Ghana compared to pulmonary TB (PTB) patients and identify risk factors for mortality among EPTB patients. We conducted retrospective analyses of demographic and clinical data accessed from medical records of EPTB and PTB patients from different types of health facilities from June 2010 to December 2013. Factors at diagnosis associated with EPTB compared to pulmonary TB (PTB) and factors associated with treatment outcome death among EPTB patients were assessed using logistic regression. Out of 3,342 new TB patients ≥15 years diagnosed, 728 (21.8%) had EPTB with a male: female ratio of 1.17. The EPTB sites commonly affected were disseminated 32.8%, pleura 21%, spine 13%, and Central Nervous System (CNS) 11%. Treatment success rate for EPTB was 70.1% compared to 84.2% for PTB (p<0.001). In logistic regression, HIV positivity (adjusted Odds Ratio [aOR] 3.19; 95% confidence interval [CI] 2.69-3.79) and female gender (aOR 1.59; 95% CI 1.35-1.88) were found to be significantly associated with EPTB compared with PTB. Older age, being HIV positive (aOR 3.15; 95% CI 1.20-8.25) and having CNS TB (aOR 3.88; 95% CI 1.14-13.23) were associated with mortality among EPTB patients. While more EPTB patients were diagnosed in the tertiary hospital, health facility type was not associated with mortality. EPTB patients in Accra have a worse treatment outcome compared to PTB patients with mortality of EPTB being associated with HIV, older age and CNS TB. Being HIV positive and female gender were found to be significantly associated with EPTB. Increased awareness of these factors may facilitate early case finding and better management outcomes for these patients.