Identification of Risk Factors for Mortality Due to Multidrug-Resistant Tuberculosis Among Patients Managed at the Lufungula Tuberculosis Screening and Treatment Center in the National Police Health Zone, Kinshasa Provincial Health Division: A Survival Analysis.

Authors

  • Jacques Nkolangi Bakokela Higher Institute of Medical Techniques de Kinshasa, Kinshasa, RDC
  • Gérard Eloko Eya Matengelo Higher Institute of Medical Techniques de Kinshasa, Kinshasa, RDC
  • Bob Senker Ndimba Senior Lecturer, PhD Candidate in Public Health, University of Ngaoundéré, Cameroon.
  • Emmanuel Kitete Mulongo Faculty of Science and Technology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
  • Mbadu Zebe Higher Institute of Medical Techniques de Kinshasa, Kinshasa, RDC
  • Jean-Paul Ngbolua Koto-Te-Nyiwa Faculty of Science and Technology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
  • Jules Kangite Moti Higher Institute of Medical Techniques de Kinshasa, Kinshasa, RDC

DOI:

https://doi.org/10.51168/e9qmmt98

Keywords:

risk factors, mortality, multidrug-resistant tuberculosis, survival, treatment adherence, Kinshasa, Democratic Republic of Congo.

Abstract

Introduction:

 Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem, particularly in sub-Saharan Africa. The Democratic Republic of Congo (DRC) is among the countries with a high burden of tuberculosis and multidrug-resistant tuberculosis. Identifying factors associated with mortality is essential to improving patient management and survival. This study aimed to identify risk factors for mortality among patients with MDR-TB followed at the Lufungula Tuberculosis Screening and Treatment Health Center, in the National Police Health Zone, Kinshasa.

 Methods:

A retrospective study was conducted using data from 404 patients aged 20 to 54 years, registered between 2010 and 2019. Exhaustive sampling was used. Data were analyzed using SPSS version 25, R, and Stata 12. Survival analysis was performed using the Kaplan-Meier and Cox methods to identify factors associated with mortality.

 Results:

 Mortality was significantly higher among patients aged 20–29 years (p<0.001). The main factors associated with mortality were treatment interruption (p=0.044), treatment failure (p=0.001), relapse (p<0.001), missed appointments (p<0.001), tobacco use (p=0.013), alcohol consumption (p=0.048), and a family history of MDR-TB (p<0.001). Shorter survival was also observed among patients who were unaware of their MDR-TB status and those who experienced treatment failure, relapse, or poor treatment adherence.

 Conclusion:

Mortality related to MDR-TB is associated with sociodemographic, behavioral, and therapeutic factors. Strengthening early diagnosis, therapeutic education, patient follow-up, and treatment adherence is essential to improving patient survival.

References

1. Alemu, A., Bitew, Z. W., Worku, T., Gamtesa, D. F., & Alebel, A. (2021). Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis. PLoS ONE, 16(6), e0253848. https://doi.org/10.1371/journal.pone.0253848

2. Ahmad, A. M., Akhtar, S., Hasan, R., Khan, J. A., Hussain, S. F., & Rizvi, N. (2012). Risk factors for multidrug-resistant tuberculosis in urban Pakistan: A multicenter case-control study. International Journal of Mycobacteriology, 1(3), 137–142. https://doi.org/10.1016/j.ijmyco.2012.07.007

3. Casal, M., Vaquero, M., Rinder, H., Tortoli, E., Grosset, J., Rüsch-Gerdes, S., Gutiérrez, J., & Jarlier, V. (2005). A case-control study for multidrug-resistant tuberculosis: Risk factors in four European countries. Microbial Drug Resistance, 11(1), 62–67.

4. Charalambous, S., Maraba, N., Jennings, L., Rabothata, I., Cogill, D., Mukora, R., Hippner, P., Naidoo, P., Xaba, N., Mchunu, L., Velen, K., Orrell, C., & Fielding, K. L. (2024). Treatment adherence and clinical outcomes amongst people with drug-susceptible tuberculosis using medication monitoring and differentiated care approach compared with standard of care in South Africa: A cluster randomized trial. eClinicalMedicine, 75, 102745. https://doi.org/10.1016/j.eclinm.2024.102745

5. Chidambaram, V., Tun, N. L., Majella, M. G., Ruelas Castillo, J., Ayeh, S. K., Kumar, A., Neupane, P., Sivakumar, R. K., Win, E. P., Abbey, E. J., Wang, S., Zimmerman, A., Blanck, J., Gupte, A., Wang, J.-Y., & Karakousis, P. C. (2021). Male sex is associated with worse microbiological and clinical outcomes following tuberculosis treatment: A retrospective cohort study, a systematic review of the literature, and meta-analysis. Clinical Infectious Diseases, 73(9), 1580–1588. https://doi.org/10.1093/cid/ciab527

6. Dumo Lodiong, L. J., Izudi, J., & Lumori, B. A. E. (2024). Treatment success and mortality among people with multidrug-resistant and rifampicin-resistant tuberculosis on bedaquiline-based regimen at three referral hospitals in Uganda: A retrospective analysis. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 37, 100499. https://doi.org/10.1016/j.jctube.2024.100499

7. Getahun, G. K., Gezahegn, E., Endazenawe, G., Shitemaw, T., Negash, Z., & Dessu, S. (2023). Survival status and risk factors for mortality among multidrug-resistant tuberculosis patients in Addis Ababa, Ethiopia: A retrospective follow-up study. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 33, 100398. https://doi.org/10.1016/j.jctube.2023.100398

8. Greenwood, F., Kamara, R. F., Conteh, O., Harding, R., Foray, L., Wingfield, T., & Saunders, M. (2026). Treatment outcomes and post-treatment mortality among people with multidrug/rifampicin-resistant tuberculosis in Sierra Leone: A national cohort study. The Lancet Regional Health – Africa, 100061. https://doi.org/10.1016/j.lanafr.2026.100061

9. Kajogoo, V. D., Lalashowi, J., Olomi, W., Atim, M. G., Assefa, D. G., & Sabi, I. (2022). Treatment outcomes of multidrug-resistant tuberculosis patients with or without human immunodeficiency virus co-infection in Africa and Asia: Systematic review and meta-analysis. Annals of Medicine and Surgery, 78, 103753. https://doi.org/10.1016/j.amsu.2022.103753

10. Kamara, R. F., Saunders, M. J., Sahr, F., Losa-Garcia, J. E., Foray, L., Davies, G., & Wingfield, T. (2022). Social and health factors associated with adverse treatment outcomes among people with multidrug-resistant tuberculosis in Sierra Leone: A national, retrospective cohort study. The Lancet Global Health, 10(4), e543–e554. https://doi.org/10.1016/S2214-109X(22)00004-3

11. Kashongwe, I. M., Mawete, F., Mbulula, L., Nsuela, D. J., Losenga, L., Anshambi, N., Aloni, M., Kaswa, M., Kayembe Ntumba, J. M., Umba, P., Bompeka Lepira, F., & Kashongwe, Z. M. (2020). Outcomes and adverse events of pre- and extensively drug-resistant tuberculosis patients in Kinshasa, Democratic Republic of the Congo: A retrospective cohort study. PLoS ONE, 15(8), e0236264. https://doi.org/10.1371/journal.pone.0236264

12. Kizito, E., Musaazi, J., Mutesasira, K., Twinomugisha, F., Namwanje, H., Kiyemba, T., Freitas Lopez, D. B., Nicholas, N. S., Nkolo, A., Birabwa, E., Dejene, S., & Zawedde-Muyanja, S. (2021). Risk factors for mortality among patients diagnosed with multidrug-resistant tuberculosis in Uganda: A case-control study. BMC Infectious Diseases, 21, 292. https://doi.org/10.1186/s12879-021-05967-2

13. Lalashowi, J., Myungi, H., Mwaisango, Z., Pamba, D., Mohamed, A., Gitige, C., Shayo, P. J., Lekule, I., Omary, H., Kisonga, R., Matechi, E., Mpagama, S. G., Olomi, W., Ntinginya, N. E., & Kalolo, A. (2025). Patients’ acceptability, adherence and satisfaction on the modified shorter all-oral multidrug-resistant tuberculosis regimen: A two-phase cross-sectional study in Tanzania. BMJ Open, 15, e088556. https://doi.org/10.1136/bmjopen-2024-088556

14. Musafiri, E. M., Kabesha, B. T., Birembano, F., Nyota, R., Mapendo, M. C., Chirambiza, J. P., Mosomo, T. K., & Namegabe, E. N. (2026). Drug-resistant tuberculosis outcomes in South Kivu Province, Democratic Republic of the Congo, during a humanitarian crisis (2018–2024). Open Forum Infectious Diseases, 13(5), ofag303. https://doi.org/10.1093/ofid/ofag303

15. Nicholson, T. J., Hoddinott, G., Seddon, J. A., Claassens, M. M., van der Zalm, M. M., Lopez, E., Bock, P., Caldwell, J., Da Costa, D., de Vaal, C., Dunbar, R., Du Preez, K., Hesseling, A. C., Joseph, K., Kriel, E., Loveday, M., Marx, F. M., Meehan, S.-A., Purchase, S., Naidoo, K., Naidoo, L., Solomon-Da Costa, F., Sloot, R., & Osman, M. (2023). A systematic review of risk factors for mortality among tuberculosis patients in South Africa. Systematic Reviews, 12, 23. https://doi.org/10.1186/s13643-023-02175-8

16. Suárez-García, I., Rodríguez-Blanco, A., Vidal-Pérez, J. L., García-Viejo, M. A., Jaras-Hernández, M. J., López, O., & Noguerado-Asensio, A. (2009). Risk factors for multidrug-resistant tuberculosis in a tuberculosis unit in Madrid, Spain. European Journal of Clinical Microbiology & Infectious Diseases, 28(4), 325–330. https://doi.org/10.1007/s10096-008-0627-y

17. Toft, A. L., Dahl, V. N., Sifna, A., Ige, O. M., Schwoebel, V., Souleymane, M. B., Piubello, A., & Wejse, C. (2022). Treatment outcomes for multidrug- and rifampicin-resistant tuberculosis in Central and West Africa: A systematic review and meta-analysis. International Journal of Infectious Diseases, 124, S107–S116. https://doi.org/10.1016/j.ijid.2022.08.015

18. Tola, H., Holakouie-Naieni, K., Mansournia, M. A., Yaseri, M., Gamtesa, D. F., Tesfaye, E., Mahamed, Z., & Sisay, M. M. (2021). National treatment outcome and predictors of death and treatment failure in multidrug-resistant tuberculosis in Ethiopia: A 10-year retrospective cohort study. BMJ Open, 11(8), e040862. https://doi.org/10.1136/bmjopen-2020-040862

19. Vidyasagaran, A. L., Readshaw, A., Boeckmann, M., Jarde, A., Siddiqui, F., Marshall, A.-M., Akram, J., Golub, J. E., Siddiqi, K., & Dogar, O. (2024). Is tobacco use associated with risk of recurrence and mortality among people with TB?: A systematic review and meta-analysis. Chest, 165(1), 22–47. https://doi.org/10.1016/j.chest.2023.08.021

20. World Health Organization. (2024). Global tuberculosis report 2024. World Health Organization.

21. World Health Organization. (2025). Global tuberculosis report 2025. World Health Organization.

Downloads

Published

2026-09-01

Issue

Section

Section of Microbiology Research

How to Cite

Jacques, Gerard, Bob Senker Ndimba, Emmanuel, Mbadu, Z., Jean-Paul, & Jules. (2026). Identification of Risk Factors for Mortality Due to Multidrug-Resistant Tuberculosis Among Patients Managed at the Lufungula Tuberculosis Screening and Treatment Center in the National Police Health Zone, Kinshasa Provincial Health Division: A Survival Analysis. Student’s Journal of Health Research Africa, 7(3), 24. https://doi.org/10.51168/e9qmmt98

Most read articles by the same author(s)

1 2 > >>