Factors Associated with Mortality among Patients with Drug Sensitive Tuberculosis in Selected Counties, Kenya, 2021-2023

Abstract Background Tuberculosis (TB) remains a significant public health challenge in Kenya, contributing to high mortality rates despite efforts to improve diagnosis and treatment. Understanding the factors associated with mortality among patients with drug-sensitive TB is crucial for enhancing TB control strategies and reducing deaths. Methods The study conducted a retrospective analysis of TB surveillance data from selected counties after validating it through annual performance review meetings. It included patients with drug-sensitive tuberculosis reported monthly through the TB Information Basic Unit (TIBU) electronic reporting system by sub-county coordinators. Sociodemographic and clinical data were collected at enrollment, including age, sex, type of TB, sputum and chest X-ray results, body weight, BMI, follow-up smears, treatment regimen, date of drug collection, HIV status, comorbidities, ART usage, nutritional assessment, and treatment outcomes. Data abstraction was performed from the national TB and Leprosy control program database on March 7, 2023. Results A total of 47,727 TB patients were included in the study. The majority were male (61.8%) and adults aged 15–34 years (41.1%). Overall, 6.1% had a mortality outcome. Mortality was higher among adults (92.1%) compared to children (7.9%), and among underweight TB patients (52.7%). HIV-positive TB patients accounted for 54.3% of reported deaths. Most deaths occurred among new TB cases (91.4%) and extra-pulmonary TB patients (76.7%). Significant predictors of TB outcomes included age (especially 55+), underweight BMI, HIV-positive status, extra-pulmonary TB, certain treatment regimens (2RHZ/4RH and 2RHZE/4RH), abnormal X-rays, and county of residence. Conclusions The study highlights that mortality among patients with drug-sensitive tuberculosis is a result of biological, clinical, and health-system factors. The high mortality rate signals a challenge to translate global advances into favorable patient outcomes. Addressing diagnostic accuracy and the interconnected social and health disparities is crucial to reducing preventable mortality.