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Tuberculosis case fatality in India: a systematic review and meta-analysis
Sophie Huddart1,2, Anita Svadzian1,2, Vaidehi Nafade1,2
1Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada.
BMJ Global Health
|March 6, 2020
Summary
India
Area of Science:
- Public Health
- Epidemiology
- Infectious Diseases
Background:
- India contributes significantly to global tuberculosis (TB) deaths.
- The World Health Organization's End TB Strategy aims to reduce the global case fatality ratio (CFR) to below 5%.
Purpose of the Study:
- To systematically review and estimate the case fatality ratios (CFRs) among Indian patients with TB during and after treatment.
- To identify factors associated with increased TB case fatality in India.
Main Methods:
- Systematic search of Medline, Embase, and Global Health databases for studies published between 2006 and 2019.
- Inclusion of cohort studies and intervention control arms following Indian TB patients.
- Pooled CFR estimation using random-effects models and meta-regression for associated factors.
Main Results:
- A pooled treatment phase CFR of 5.16% was estimated, reducing to 3.78% in high-quality studies.
- Higher CFRs were observed in pediatric, drug-resistant, and HIV-infected TB patients.
- Poor study quality and treatment in tertiary centers were associated with increased CFR.
Conclusions:
- India's treatment CFRs align with WHO targets, but methodological issues persist in most studies.
- Key patient groups, including pediatric, drug-resistant, and HIV-infected TB patients, require further research.
- Enhanced high-quality reporting on patient outcomes is crucial for improving TB care evidence.
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