Takemi Program in International Health
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Impact of COVID-19 on tuberculosis mortality and multidrug-resistance in Burundi:
A Case-Control Study
Arnaud Iradukunda,a Fentabil Getnet,b Emmanuel Nene Odjidja,c and Stéphane Verguet a
a. Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA
b. National Data Management Center for Health, Ethiopian Public Health Institute, Ethiopia
c. Department of Clinical Medicine, Monash University, Australia
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Introduction
Background
- Since 2019, Tuberculosis and COVID-19 have become the main causes of illness and death globally. TB control programs have not been sufficient to address the existing burden of TB and MDR-TB in Burundi. Gaps in the TB control program include treatment adherence issues, challenges in prevention, diagnosis, treatment of MDR-TB, as well as exacerbation from new pandemics.
- Before COVID-19, Burundi, as well as many LICs, had been grappling with a high burden of TB infection for years. The incidence of multidrug-resistant tuberculosis (MDR-TB) was a growing issue.
Added Value
- This study will shed light on how the COVID-19 pandemic might have affected TB all-cause mortality rates and the risk of MDR-TB infection in Burundi.
- This insight is crucial for understanding the broader impact of the pandemic on existing health conditions in Burundi.
Objectives
- To assess the impact of COVID-19 on TB mortality in Burundi.
- To assess the MDR-TB risk factors in the context of COVID-19 in Burundi.
Methods
- We conducted an incident case-control study on 362 patients who received TB treatment before or after the World Health Organization’s declaration of COVID-19 as a pandemic.
- Baseline and follow-up data were used.
- We used descriptive methods to compare TB mortality before and during COVID-19, and a logistic regression model to assess the risk factors of MDR-TB in the context of COVID-19. Lastly, we used Machine Learning (ML) to assess and build an MDR-TB prediction model.
- This study was funded by the JPMA and conducted in accordance with the Helsinki Declaration.
Key Findings
TB Mortality
TB all-cause mortality before and during COVID-19
- 16.02% of tuberculosis patients died while under TB treatment.
- TB mortality rate did not significantly increase from 15.3% before COVID-19 to 17.1% during the pandemic.
- MDR-TB and early TB mortalities (intensive phase of treatment) significantly increased during COVID-19.
- MDR-TB was more prevalent during COVID-19, especially in rural areas, smokers, alcohol consumers, diabetics, and malnourished individuals.
TB mortality during the intensive phase of treatment
- 70.14% of deaths occurred during the intensive phase of treatment.
- More than half of the deaths among MDR-TB patients occurred during the first two months of treatment.
Key Factors Influencing
Multidrug-Resistance
Tuberculosis
Factors associated with MDR-TB in the context of COVID-19 in Burundi
Lessons Learned
- TB all-cause mortality as well as the multidrug-resistance infection’s risk increased during COVID-19.
- TB and MDR-TB early mortality were high and significantly increased during COVID-19.
- Both early TB and MDR-TB mortality were particularly observed in patients with a low socio-economic status.
- Risk factors of MDR-TB include the COVID-19 pandemic period, socio-economic, demographic, clinical, and therapeutic conditions.
Recommendations
- This situation raises a cause for concern, especially in this context where there exists an equally high burden of communicable and non-communicable diseases including malnutrition.
- A global approach focused on these identified factors could go a long way in a MDR-TB-free environment in Burundi.
- Additional studies should focus on advanced screening techniques of Artificial Intelligence and Machine Learning as well as early TB mortality predictors and identifications.
Policy Implication
Understanding how the pandemic affected TB control efforts can help policymakers develop strategies to mitigate the impact of future pandemics.
References
- Chakaya, J., et al., The WHO Global Tuberculosis 2021 Report–not so good news and turning the tide back to End TB. International Journal of Infectious Diseases, 2022.
- Bagcchi, S., WHO’s global tuberculosis report 2022. The Lancet Microbe, 2023.
Acknowledgements
Burundian Health Facilities (Burundi), TAKEMI Program (Harvard), JPMA (Japan), Michael Reich (Harvard), Aya Goto (Harvard), Jesse Bump (Harvard).