Reducing the burden of tuberculosis and sepsis in Gabon Clinical and epidemiological investigations for improved control

Each year, an estimated 1.5 and 11 million people died of tuberculosis and sepsis, respectively. Most cases occur in Low and Middle-Income Countries (LMICs). Gabon is listed in the top 30 tuberculosis/HIV high-burden countries. Studies performed for this thesis investigated the contributors to the burden of tuberculosis and sepsis in Gabon and suggested actions for improved control. Several research designs including a pragmatic clinical trial, systematic review and meta-analysis, cross-sectional, operational and qualitative studies have been combined to generate the outcomes reported in this thesis. The main findings were the following. There is a high prevalence of smoking in tuberculosis patients in Gabon (30%) and smoking is associated with diagnostic delay. Forty-six per cent (46%) of the tuberculosis patients had at least either dyslipidaemia, hypertension, diabetes, or obesity with a majority of newly-diagnosed hypertension and diabetes. One patient out of three with drug-resistant tuberculosis has never been treated for tuberculosis before, highlighting the urgent need to improve drug-resistant tuberculosis case-finding strategies at the community level for early diagnosis and treatment. Almost 64% of HIV-negative patients with tuberculosis sepsis died, and the diagnosis was obtained for 85% of them only post-mortem. Individual sepsis predicting scores such as qSOFA, SIRS, MEWS, and UVA, could not identify sepsis patients with accuracy but should be combined for better performance. Sepsis is a silent killer in many countries. Future research should be designed to provide the evidence needed to engage health policy stakeholders to consider sepsis as a global health priority.