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The timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South India

Subbanna Jonnalagada1*, Anthony D Harries23, Rony Zachariah4, Srinath Satyanarayana5, Shailaja Tetali6, G Keshav Chander7, Srinivas Rao8, Ranganadha Rao9, Sundaresh Peri9, Raghupathy Anchala10 and Nanda K Kannuri10

Author Affiliations

1 LEPRA India - Blue Peter Public Health & Research Centre, Near TEC Building, Cherlapally, Hyderabad 501301, Andhra Pradesh, India

2 International Union Against Tuberculosis and Lung Disease (The Union), 68 boulevard Saint Michel, Paris 75006, France

3 Department of Clinical Research, London School of Hygiene and Tropical Medicine, 50 Bedford Square, London WC1B 3DP, UK

4 Medecins Sans Frontieres, Medical Department (Operational Research), Operational Center, Brussels, Luxembourg

5 International Union against Tuberculosis and Lung Diseases (The Union), South East Asia, Regional Office, C-6, Qutub Institutional Area, New Delhi 110016, India

6 Public Health Foundation of India - Indian Institute of Public Health, Plot no # 1, Amar, Co-op Society, ANV Arcade, Madhapur, Kavuri Hills, Hyderabad 500033, India

7 Department of Health & Family Welfare, Government of Andhra Pradesh, Koti, Sultan, Bazar, Hyderabad 500015, India

8 State TB Office, Department of Health Services, Government of Andhra Pradesh, Koti, Sultan Bazar, Hyderabad 500015, India

9 LEPRA India, Krishnapuri colony, West Marredpally, Hyderabad 500026, India

10 Public Health Foundation of India - Indian Institute of Public Health, Plot no # 1, Amar Co-op Society, ANV Arcade, Madhapur, Kavuri Hills, Hyderabad 500033, India

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BMC Public Health 2011, 11:921  doi:10.1186/1471-2458-11-921

Published: 13 December 2011



India has 2.0 million estimated tuberculosis (TB) cases per annum with an estimated 280,000 TB-related deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India:- i) treatment outcomes including the number who died while on treatment, ii) the month of death and iii) characteristics associated with "early" death, occurring in the initial 8 weeks of treatment.


This was a retrospective study in 16 selected Designated Microscopy Centres (DMCs) in Hyderabad, Krishna and Adilabad districts of Andhra Pradesh, South India. A review was performed of treatment cards and medical records of all TB patients (adults and children) registered and placed on standardized anti-tuberculosis treatment from January 2005 to September 2009.


There were 8,240 TB patients (5183 males) of whom 492 (6%) were known to have died during treatment. Case-fatality was higher in those previously treated (12%) and lower in those with extra-pulmonary TB (2%). There was an even distribution of deaths during anti-tuberculosis treatment, with 28% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with "early death".


In this large cohort of TB patients, deaths occurred with an even frequency throughout anti-TB treatment. Reasons may relate to i) the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii) co-morbidities, such as HIV/AIDS and diabetes mellitus, which are known to influence mortality. More research in this area from prospective and retrospective studies is needed.

Tuberculosis; India; Death; Timing of death