{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:51:50Z","timestamp":1782323510048,"version":"3.54.5"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite decades of global efforts and the availability of curative and preventive measures, tuberculosis (TB) continues to be the world\u2019s leading infectious disease cause of mortality, particularly in resource-limited settings. However, in developing countries, there is limited evidence on determinants of mortality during TB treatment, making it difficult to design targeted interventions. This study aimed to determine the incidence and factors associated with mortality among people diagnosed with TB at a rural health facility in Zambia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study among 316 individuals who started TB treatment between May 2019 and March 2024. Participants were followed from treatment initiation until a treatment outcome was recorded, with a maximum follow-up time of 12 months. Demographic and clinical information were collected from medical records using a data collection tool via KoboTool software. The primary outcome was mortality. We used a multivariable Cox regression model to identify factors associated with TB mortality using Stata version 15.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The participants had a median age of 41 years (IQR: 32\u201354) and a median follow-up of 174 days (IQR: 155\u2013191). Overall, 19.0% (n\u2009=\u200960; 95% CI: 14.8\u201323.8) of participants died, corresponding to an incidence rate of 42.1 per 100 person-years based on 51,968 person-days of follow-up (95% CI: 31.6\u201354.0). Age (adjusted hazard ratio (aHR): 1.017, 95% CI: 1.000\u20131.033, P\u2009=\u20090.042), clinically diagnosed TB had a significantly higher risk of mortality compared to those with bacteriologically confirmed TB (aHR: 1.97, 95% CI: 1.14\u20133.41, p\u2009=\u20090.015), and People living with HIV (aHR: 1.84, 95% CI: 1.03\u20133.29, P\u2009=\u20090.039) were significantly associated with increased mortality. While being on family-based directly observed therapy (DOT) (aHR: 0.42, 95% CI: 0.24\u20130.74, P\u2009=\u20090.003) and every unit increase in baseline weight (aHR: 0.96, 95% CI: 0.92\u20130.99, p\u2009=\u20090.004) was associated with a reduced risk of mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study reveals a high incidence of TB-related mortality in a rural setting, which is significantly influenced by demographic and clinical determinants. The findings highlight the need for closer evaluation of patients with clinically diagnosed TB and strengthening family-based DOT as strategies to reduce mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345056","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:30:42Z","timestamp":1782322242000},"page":"e0345056","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of tuberculosis mortality among patients on treatment: A retrospective cohort study at a rural general hospital in Zambia"],"prefix":"10.1371","volume":"21","author":[{"given":"Collins","family":"Mukubesa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4810-7352","authenticated-orcid":true,"given":"Lukundo","family":"Siame","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malan","family":"Malumani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faceroy","family":"Nkole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5230-1882","authenticated-orcid":true,"given":"Propheria C.","family":"Lwiindi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matenge","family":"Mutalange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geofrey","family":"Mupeta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Memory","family":"Ngosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4997-2487","authenticated-orcid":true,"given":"Martin","family":"Chakulya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benson M.","family":"Hamooya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1186-5045","authenticated-orcid":true,"given":"Chitalu","family":"Chanda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"issue":"2","key":"pone.0345056.ref001","doi-asserted-by":"crossref","first-page":"324","DOI":"10.58578\/ajcmpr.v2i2.5455","article-title":"Tuberculosis in the 21st Century: Challenges in diagnosis, treatment, and global control","volume":"2","author":"M Akram","year":"2025","journal-title":"Afr J Clin Med Pharm Res"},{"key":"pone.0345056.ref002","unstructured":"WHO. Global tuberculosis report 2021. 2021. https:\/\/www.who.int\/publications\/i\/item\/9789240037021"},{"issue":"4","key":"pone.0345056.ref003","doi-asserted-by":"crossref","first-page":"964","DOI":"10.9745\/GHSP-D-21-00368","article-title":"Lessons learned during the COVID-19 pandemic to strengthen TB infection control: A rapid review","volume":"9","author":"HJ Chapman","year":"2021","journal-title":"Glob Health Sci Pract"},{"key":"pone.0345056.ref004","unstructured":"WHO. Country Disease Outlook Zambia. https:\/\/www.afro.who.int\/sites\/default\/files\/2023-08\/Zambia.pdf. 2023. Accessed 2024 June 15."},{"issue":"6","key":"pone.0345056.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003329","article-title":"Mortality among persons with tuberculosis in Zambian hospitals: A retrospective cohort study","volume":"4","author":"J Bwembya","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"10","key":"pone.0345056.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003686","article-title":"Tuberculosis-related deaths at a tertiary hospital in Zambia: Insights into the prevalence and associated factors","volume":"4","author":"L Siame","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"2","key":"pone.0345056.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001234","article-title":"Mortality among persons receiving tuberculosis treatment in Itezhi-Tezhi District of Zambia: A retrospective cohort study","volume":"3","author":"E Chaaba","year":"2023","journal-title":"PLOS Glob Public Health"},{"issue":"11","key":"pone.0345056.ref008","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.5588\/ijtld.18.0045","article-title":"Convergence of non-communicable diseases and tuberculosis: A two-way street?","volume":"22","author":"MJ Magee","year":"2018","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0345056.ref009","unstructured":"WHO. 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Tuberculosis Manual for Zambia. 2017. https:\/\/www.afro.who.int\/sites\/default\/files\/2019-06\/4%20%20Tuberculosis%20Manual%20for%20Zambia_Final.pdf"},{"key":"pone.0345056.ref011","unstructured":"WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents. 2022. https:\/\/www.who.int\/publications\/i\/item\/9789240046764"},{"key":"pone.0345056.ref012","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jclinepi.2016.02.031","article-title":"Adequate sample size for developing prediction models is not simply related to events per variable","volume":"76","author":"EO Ogundimu","year":"2016","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"pone.0345056.ref013","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1186\/s12879-019-4709-5","article-title":"Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia","volume":"19","author":"S Mutembo","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"12","key":"pone.0345056.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0144244","article-title":"Time to death and associated factors among tuberculosis patients in Dangila Woreda, Northwest Ethiopia","volume":"10","author":"A Birlie","year":"2015","journal-title":"PLoS One"},{"key":"pone.0345056.ref015","doi-asserted-by":"crossref","DOI":"10.5588\/pha.18.0068","article-title":"A mortality review of adult inpatients with tuberculosis in Mendi, Papua New Guinea","volume":"9","author":"K Vakadem","year":"2019","journal-title":"Public Health Action"},{"key":"pone.0345056.ref016","author":"PP Thin","year":"2020"},{"issue":"1","key":"pone.0345056.ref017","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1186\/s12879-019-4063-7","article-title":"Tuberculosis mortality and associated factors at King Abdulaziz Medical City Hospital","volume":"19","author":"R Aljadani","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"3","key":"pone.0345056.ref018","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1093\/infdis\/jiz138","article-title":"The lung mucosa environment in the elderly increases host susceptibility to mycobacterium tuberculosis infection","volume":"220","author":"JI Moliva","year":"2019","journal-title":"J Infect Dis"},{"issue":"1","key":"pone.0345056.ref019","doi-asserted-by":"crossref","first-page":"105","DOI":"10.4103\/sujhs.sujhs_22_24","article-title":"Tuberculosis in the elderly population","volume":"10","author":"A Gupta","year":"2024","journal-title":"Santosh University Journal of Health Sciences"},{"key":"pone.0345056.ref020","doi-asserted-by":"crossref","first-page":"143","DOI":"10.2147\/HIV.S354436","article-title":"Increased mortality in HIV infected individuals with tuberculosis: A retrospective cohort study, Addis Ababa, Ethiopia","volume":"14","author":"E Seyoum","year":"2022","journal-title":"HIVAIDS - Res Palliat Care"},{"issue":"1","key":"pone.0345056.ref021","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s41182-020-00212-z","article-title":"Effect of tuberculosis infection on mortality of HIV-infected patients in Northern Tanzania","volume":"48","author":"EW Mollel","year":"2020","journal-title":"Trop Med Health"},{"issue":"2","key":"pone.0345056.ref022","article-title":"Diagnostic dilemma of tuberculosis among HIV-positive patients: Challenges and advances","volume":"6","author":"M Sharma","year":"2024","journal-title":"Z H Sikder Women\u2019s Med Coll J"},{"issue":"1","key":"pone.0345056.ref023","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1186\/s12879-017-2249-4","article-title":"High mortality among tuberculosis patients on treatment in Nigeria: A retrospective cohort study","volume":"17","author":"AL Adamu","year":"2017","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0345056.ref024","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12889-016-3972-2","article-title":"Risk factors for mortality in TB patients: A 10-year electronic record review in a South African province","volume":"17","author":"JC Heunis","year":"2017","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0345056.ref025","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1186\/s13104-018-3806-7","article-title":"Time to death and risk factors among tuberculosis patients in Northern Ethiopia","volume":"11","author":"SW Asgedom","year":"2018","journal-title":"BMC Res Notes"},{"issue":"11","key":"pone.0345056.ref026","article-title":"Patterns of non-communicable comorbidities at start of tuberculosis treatment in three regions of the Philippines: The St-ATT cohort","volume":"1","author":"SE Cox","year":"2021","journal-title":"PLOS Glob Public Health"},{"issue":"5","key":"pone.0345056.ref027","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.4269\/ajtmh.21-0072","article-title":"Strengthening the mentorship and leadership capacity of HIV\/AIDS and tuberculosis researchers in South Africa","volume":"105","author":"MM Desai","year":"2021","journal-title":"Am J Trop Med Hyg"},{"issue":"12","key":"pone.0345056.ref028","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1017\/S0007114517003166","article-title":"Underweight increases the risk of early death in tuberculosis patients","volume":"118","author":"Y-F Yen","year":"2017","journal-title":"Br J Nutr"},{"key":"pone.0345056.ref029","article-title":"Lack of weight gain and increased mortality during and after treatment among adults with drug-resistant tuberculosis in Georgia, 2009-2020","author":"T Chakhaia","year":"2024","journal-title":"MedRxiv Prepr Serv Health Sci"},{"issue":"6","key":"pone.0345056.ref030","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0231821","article-title":"Characteristics and predictors for tuberculosis related mortality in Denmark from 2009 through 2014: A retrospective cohort study","volume":"15","author":"IK Holden","year":"2020","journal-title":"PLoS One"},{"key":"pone.0345056.ref031","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.3389\/fimmu.2017.01316","article-title":"Malnutrition: Modulator of immune responses in tuberculosis","volume":"8","author":"P Chandrasekaran","year":"2017","journal-title":"Front Immunol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345056","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:30:59Z","timestamp":1782322259000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345056"}},"subtitle":[],"editor":[{"given":"Graeme","family":"Hoddinott","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":31,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0345056","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}