Patients with tuberculosis in Bolivia: why do they die?

The objective of this research was to analyze why patients with tuberculosis (TB) die and to evaluate whether there are factors contributing to their fatal outcome that could be corrected. A cross-sectional observational study was conducted of the patients with active TB or its sequelae admitted to the TB ward of the main public hospital in the city of Santa Cruz, Bolivia, over a 29-month period, from October 1993 through February 1996. The available records of the patients who died during hospitalization were reviewed. Out of 597 patients, 94 of them (15.7%) died. We examined the records of 90 of these 94 patients. Their mean age was 35.1 years (standard deviation, 16.7 years), and 45 of the patients (50.0%) were male. On admission 42 of the 90 patients (46.7%) had never been treated for TB or had received anti-TB treatment for less than one month, 23 (25.6%) had returned after having abandoned their TB treatment, 8 (8.9%) had had an erroneous diagnosis, 6 (6.7%) had tuberculosis sequelae, 6 (6.7%) were undergoing tuberculosis treatment, and 5 (5.6%) were known to have multidrug-resistant TB. Of the 90 patients, 83 (92.2%) had pulmonary tuberculosis (median lobes affected, 4), 6 (6.7%) had pleural tuberculosis, and 12 (13.3%) had extrapulmonary tuberculosis (some patients had more than one form of TB). Patients died a median of 5.5 days after entering the TB ward. The causes of death were: hemoptysis, 6 patients (6.7%); other tuberculosis-related causes, 65 patients (72.2%); drug reactions, 6 patients (6.7%); nontuberculosis causes, 6 patients (6.7%); and undetermined causes, 7 patients (7.8%). Factors possibly contributing to death were late diagnosis (38.9%), errors in follow-up (14.4%), and errors in treatment (24.4%). In conclusion, most patients with active or inactive TB admitted to our ward died as a consequence of tuberculosis. There were several factors possibly contributing to their fatal outcome that could be corrected.