Diagnosis and Management of Hospitalized Patients with Suspected or Confirmed Tuberculosis in Luanda, Angola: A Retrospective Analysis of a Single-Center Cohort

Background In 2022 the Tuberculosis (TB) incidence in Angola reached 333 per 100,000 people with a case fatality rate estimated at 20%. While Angola is not yet officially recognized as one of the United Nations designated "high burden" countries, TB is a public health threat made worse by the emergence of multi-drug-resistant (MDR) and extensively drug-resistant (XDR) TB. Aims This dissertation aims to provide a detailed examination of the clinical practices, diagnostic procedures, and therapeutic interventions at HDP and offer insights into patterns, challenges, and potential improvements for TB care. Secondly it aims to evaluate the economic burden of hospitalization of patients admitted to the TB ward of a public/private hospital in Luanda, the capital city. Methods A retrospective review of medical records was conducted in a cohort of patients admitted between January and November 2023, at the TB ward of the Hospital Divina Providência (HDP). Data on demographics, medical history, laboratory exams, imaging tests, treatment, and hospitalization outcome were extracted from medical records. Exclusion criteria included all patients who stayed for less than 24 hours in the hospital and thus did not receive any care at HDP. Logistic regression models were estimated to examine any association between variables. Results A total of 321 charts of TB patients were reviewed. 48.6% were male and the median age (±SD) was 37.6 (±15.6) years old. The most common presenting symptom was persistent cough that was reported by 222 participants (69.2%). HIV and Malnutrition prevalence were 29.9% (n=96) and 37.1%, (n=119) respectively. HIV testing was performed in 64.2% (n=206) of study participants. Data on diabetes, smoking and alcoholism was lacking in most charts. In-hospital mortality rate was 18% and 28% in people living with HIV (PLHIV). Positive HIV status, malnutrition and dyspnea at presentation were independently associated with in-hospital mortality. Conclusion The present study found that diagnosis and treatment of TB in HDP needs strengthening and standardization. It also demonstrated high mortality rates suggesting that early diagnosis and treatment should be implemented: fragile patients are at higher risk of dying warranting tailored interventions. In resource-limited health centers facing high TB burden, standardized protocols and better diagnostic tools will likely improve quality of care and address the disproportionate mortality rate. Key Terms Pulmonary TB, PLHIV, antibiotic resistance, latent TB, active TB