DETERMINANT OF TUBERCULOSIS AND DIABETES MELLITUS COMORBILITY AMONG NEWLY DIAGNOSED TUBERCULOSIS PATIENT ATTENDING NTBLCP CLINICS IN ABIA STATE 

DETERMINANT OF TUBERCULOSIS AND DIABETES MELLITUS COMORBILITY AMONG NEWLY DIAGNOSED TUBERCULOSIS PATIENT ATTENDING NTBLCP CLINICS IN ABIA STATE 

Abstract

Globally, tuberculosis (TB) and diabetes mellitus (DM) are a huge challenge to public health. Many developing countries including Nigeria have a very high burden of TB. Diabetes mellitus (DM) epidemic is a threat to public health and has been linked to current changes in lifestyle going on in developing countries. The aim of this study is to determine the prevalence of TB-DM co-morbidity and to assess the factors related to the occurrence of DM in TB patients among inhabitants of Abia State, Nigeria.
A total of 339 sputum positive TB patients up to 15 years diagnosed under the NTBLCP in Abia State from January 2015 to December 2015 were screened for DM with self-report and RBS and FBS. A case-control study of patients with both TB and DM (43) matched by age in the ratio of 1:3 with TB alone patients (129) randomly selected by balloting was done. Ethical clearance was obtained from Ethics and Research Committee FMC Umuahia. Interview, anthropometric measurement and biochemical assessment were done. Statistical significance testing for numeric variables was done with t-test. Univariate logistic regression was used to test association of categorical variables and outcome variable while Multivariate logistic regression was done to identify the predictors of TB-DM comorbidity.
Out of the 339 sputum positive TB patients, 199 were males and 140 females with mean ages of 42.2±13.9 years and 37.3 ± 13.9 years respectively. Forty three had DM giving a prevalence of 12.7%; being 12.6% and 12.9% for males and females respectively. Out of the DM patients 38 (88.4%) were known diabetes patients while 5 (11.6%) were previously undiagnosed giving a previously undiagnosed DM prevalence of 1.5% among TB patients. The HIV prevalence among the TB patients was 13.6% and among TB-DM patients it was 7%. Nine of them had MDR-TB of which 4 were TB-DM patients.
xii
Cases and controls had mean ages of 47.8±11.8 years and 47.5±11.8 years; mean BMI of 21.10 ± 3.96 kg/m2 and 20.10 ± 3.49 kg/m2; mean waist circumferences of 81.45 ± 14.04cm and 80.43 ± 10.92cm; mean systolic BP of 118mmHg and 116mmHg and mean RBG of 256.9±141.4mg/dl and 98±36.8mg/dl respectively. On univariate logistic regression analysis, factors significantly associated with TB-DM include HIV status (OR = 3.87; 95% CI: 1.11-13.41), drug resistance (OR: 0.24; 95% CI: 0.06-0.95), and waist circumference classes (OR = 2.76; 95% CI: 1.26 – 6.02). However on adjustment at multivariate logistic regression only HIV status and waist circumference were significant predictors of TB-DM comorbidity. HIV negative subject were about four times likely to have TB-DM than HIV positive patients (Adjusted OR = 3.8; 95% CI: 1.07- 13.30) while having increased waist circumference above two times increased risk of TB-DM than normal waist circumference (Adjusted OR = 2.45; 95% CI: 1.08 – 5.66).
In summary the prevalence of DM among TB patients is high. Tuberculosis diabetes co-morbidity is shared equally by males and females. However 1.5% diabetes mellitus among TB patients remains undiagnosed. Factors associated with TB-DM comorbidity include HIV status, drug resistance status and class of waist circumference while being HIV negative and having increased waist circumference predict TB-DM in Abia State. Non-communicable disease policy should be reviewed and implemented to ensure early detection DM in TB clinics and routine screening of TB patients for DM is recommended. Further research is needed at molecular and immunologic level to gain in-depth knowledge as regards the findings of this study.

Title Page———i

Certification——–ii

Dedication———iii

Acknowledgement——-iv

Abstract ———vi

Table of Content——–vii

 

Chapter One

1.0 Introduction ——-1

1.1 Statement of Problem——4

1.2 Purpose of the Study——5

1.3 Significance of Study——8

1.4 Limitation——–9

1.5 Scope of Study——-11

 

Chapter Two

2.0 Review of Related Literature —-12

2.6 Summary of Literature Review—- 19

 

Chapter Three

3.0 Research Methodology and Procedure—22

3.1 Population ——–22

3.2 Sample and Sampling Technique—-22

3.3 Validation of the Instrument —-23

3.4 Reliability of the Instrument —–23

3.5 Data Analysis——-23

 

Chapter Four

4.0 Presentation and Discussion of Result—24

4.1 Analysis and interpretaion of Data—25

4.2 Discussion of Results——38

 

Chapter Five

5.0. Summary, Conclusion, and Recommendation  –40

5.1 Summary——–40

5.2 Conclusion——–41

5.3 Recommendation——42

References ———45

Appendix 1——–47

Appendix ———50

DETERMINANT OF TUBERCULOSIS AND DIABETES MELLITUS COMORBILITY AMONG NEWLY DIAGNOSED TUBERCULOSIS PATIENT ATTENDING NTBLCP CLINICS IN ABIA STATE 

Sharing is caring!