Tuberculosis associated deaths: a comparative autopsy study in Accra, Ghana

Abstract

This study was conducted to find out if there were any changes in the findings at autopsy of deaths associated with tuberculosis (TB) from the period when HIV was first detected in Ghana and to see whether any such changes are correlated with the progression of the mV-AIDS epidemic. A retrospective review or autopsy files of tuberculosis-associated deaths at the Korle Bu Teaching Hospital Mortuary was done and a comparison was made between the calendar years 1987/ 1988 at the beginning of the HIV-AIDS epidemic in Ghana and 1997/98, a decade later. The proportion of deaths associated with TB in, creased significantly (X2 =' 9.17, P < 0.01, 1d.f.) from 3.2% of 4321 autopsies in 1987/88 to 5.1% of 7004 autopsies in 1997/98. The increase was largely due to deaths among patients aged 20-49 years and was more pronounced among females. The proportion of deaths associated with TB among females aged 20-49 years increased from 10% in 1987/88 to 23.9% in 1997/98. The male: female ratio decreased from 3.4: 1 to 1.9: 1 over the period. Systemic miliary TB, more than doubled from 12.9% in 1987/98 to 33.4% in 1997/98. It became the commonest form of TB detected at autopsy in the 20-29 years age group in 1997/98. A significant increase in deaths associated with TB occurred between 1987/88 and 1997/98 and the changes in the characteristics of TB associated deaths were as expected with the progression of the HIV-AIDS epidemic.