Incidence of mortality and its predictors among adult Visceral Leishmaniasis patients at University of Gondar Comprehensive Specialized Hospital, Ethiopia

Abstract Background Visceral leishmaniasis (VL) is a neglected tropical disease resulting in a huge burden of mortality and impact on development of a country. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, still there is a death of VL patients while on treatment. However, study on incidence of mortality and its predictors among these patients while on treatment is scarce in Ethiopia. Objective The aim of this study was to determine incidence of mortality and its predictors among adult VL patients at University of Gondar Hospital. Methods Institution based retrospective follow up study was conducted from 2013 to 2018 at University of Gondar Hospital. Data were collected from patients’ chart and analyzed using Stata 14. Kaplan Meier failure curve and Log Rank test was used to compare survival probability of patients with categorical variables. Multivariable stratified Cox model was used to identify predictors of mortality among VL patients. P≤ 0.05 was employed to declare statistically significant factors. Adjusted Hazard Ratio (AHR) and its 95% confidence interval (95% CI) was estimated for potential risk factors included in the multivariable model. Results A total of 586 VL patients were included in the study. The median age of patients was 23 years. The incidence of mortality was 6.6 (95% CI: 5.2 - 8.4) per 1000 person-days of observation. Independent predictors of mortality were: presence of comorbidity (AHR=2.29 (95% CI: 1.27-4.11)), relapse VL (AHR=3.03 (95% CI: 1.25-7.35)), toxicity of treatment drug (AHR=5.87 (95% CI:3.30-10.44)), nasal bleeding (AHR=2.58 (95%CI: 1.48-4.51)), jaundice (AHR=2.84 (95% CI: 1.57-5.16)) and being bedridden (AHR=3.26 (95 % CI: 1.86-5.73)). Conclusion The incidence of mortality among VL patients was high. Mortality was higher among VL patients with concomitant disease, relapse, toxicity during treatment, nasal bleeding, jaundice, and bedridden patients. Therefore, strict follow up and treatment of VL patients who have comorbidity, relapse VL, toxicity, nasal bleeding and jaundice were crucial so as to reduce the risk of mortality. Authors’ summary Visceral leishmaniasis is a neglected tropical disease caused by a protozoa parasite. Over 90% of global burden of VL occurs in poor rural and suburban areas in seven countries including our country, Ethiopia. If not appropriately treated, over 95% of VL cases will eventually die. The emergence of VL in Ethiopia places a huge burden on society as it affects poor, young and productive age group of its population. However, there is scarcity of data about incidence of mortality and its predictors among adult VL patients in Ethiopia. In this study, a registry of VL patients at Gondar University Hospital was taken to determine the incidence of VL mortality and its predictors. Mortality rate was higher among VL patients with concomitant disease, relapse, drug toxicity, nasal bleeding and jaundice. Therefore, strict follow up and treatment of VL patients who had comorbidity, relapse VL, drug toxicity, nasal bleeding and jaundice were crucial.