TB death surveillance and response (TBDSR) - A step towards zero deaths due to TB. Lessons learnt from West Bengal, India

<h2>Abstract</h2><h3>Background</h3> West Bengal, an eastern state of India, has introduced a tuberculosis (TB) death review system called TB Death Surveillance and Response (TBDSR). The State has developed a dedicated web portal for TB death information management. This study assessed the preventable factors associated with the death of a person with TB (PwTB) <h3>Methods</h3> This is a mixed-method observational study. In 2023, a total of 5,332 PwTB died due to any reason before completion of treatment. This was the study population. A secondary analysis was done on the routinely collected data from the TBDSR portal. <h3>Results</h3> The odds of death were significantly & independently higher among the elderly, males, severely underweight, extra-pulmonary TB, drug-resistant TB, HIV +ve, diabetics, and those who are not initiated with anti-TB drugs. The median time of death was 30 days after TB diagnosis. 10% died before treatment initiation, 46% died within one month, 19% died between 1-2 months.79% died at home and 2% during transit. The major underlying causes of death were TB (40%), Cerebrovascular accident (22%), and old age (17%). Contributors of deaths were delay in care seeking, self-perceived stigma, comorbidities, and unavailability of hospital admission facilities/transport facilities/critical care setup for PwTBs. <h3>Conclusion</h3> West Bengal has a well-designed system of TB death surveillance. The TBDSR model can be replicated in other high-burden areas. The majority of the PwTBs are dying at home within two months of TB diagnosis. The findings of TBDSR warrant several critical steps for the reduction of mortality due to preventable reasons.