Prevalence and Predictors of Tuberculosis among Patients with
Prevalence and Predictors of Tuberculosis among Patients with Diabetes Mellitus in Nigeria: A multi-centre study Ngozi Ekeke Medical Adviser, German Leprosy and TB Relief Association, Nigeria @ National Tuberculosis Conference, Abuja 2019 Theme: Building Stronger Partnerships to End TB in Nigeria 17 -18 July, 2019
Prevalence and Predictors of Tuberculosis among Patients with Diabetes Mellitus in Nigeria: A multi-centre study Ekeke N, 1 Chukwu J, 1 Nwafor C, 1 Meka A, 1 Alphonsus C, 1 Ezeakile O, 1 Murphy-Okpala N, 1 Ikebudu J, 1 Anyim M, 1 Aniwada E 2 1. Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu, Nigeria 2. College of Medicine, University of Nigeria Teaching Hospital, Enugu.
Introduction This framework is yet to be implemented in the Nigerian TB control program
Aim/Objective: • The aim of this study was to ascertain the prevalence of TB among DM patients as well as factors influencing the co-morbidity.
Materials and Methods • This is a cross-sectional study conducted in 2018 under routine programme settings. • Ten (10) health facilities purposively selected in 6 States across southern Nigeria.
Abia: FMC, Umuahia 6 States in southern Nigeria (2 per geopolitical zone) Enugu UNTH & ESUTH Enugu Study sites: Ondo: SSH, Akure Ogun: FMC Abeokuta SHH, Lantoro SH, Ijaiye Diabetes clinics 10 hospitals With high DM case load and accessible TB-DOTS services were purposively selected Delta: FMC Asaba & CH Warri Edo: UBTH, Benin
Training of Research Team: Training session of DM-TB research team at FMC Abeokuta before commencement of Tuberculosis screening exercise • Team: DM-TB Research team was constituted in each facility • Team was made up of: • Endocrinologist, etc. • Nurses in both TB-DOTS and DM clinics • Research Assistant (locally recruited) • Training: Each team in the selected facilities was trained for one day.
Screening process. . . TB among DM patients Over a period of six months (February to July 2018), all diagnosed DM cases aged ≥ 15 years who attended the clinics were screened for tuberculosis. Chi square test of statistical significance and binary logistic regression were used in analysis at statistical significance level of p<0. 05.
Instruments and data collection Study instruments were administered to eligible DM patients by locally recruited and trained Research Assistants in each facility Pre-tested and validated symptom-based screening tools (checklist) were used to identify presumptive TB cases • Screening Forms and Registers were used at DM clinics for documentation Entire screening process was Identified presumptive TB cases were sent routinely supervised every to Gene. Xpert for diagnosis in line with quarter by GLRA DM-TB NTBLCP guidelines. Research team to ensure quality
Results A total of 3457 DM patients were screened for TB üPresumptive TB cases = 221 (6. 4%) üTotal of 27 (0. 8%) DM patients were diagnosed with TB üSent for Xpert MTB Rif assay =184/221 (83. 3%) üNNS 315; Yield 40. 7% 34. 1% 1179 65. 9% 2278 üFemales 13(48%) üMales 14(52%) Mean (SD) age: 59. 9 (12. 9) years HIV positive = 3/3395 DM patients. None of the three had TB.
Prevalence of Tuberculosis among DM patients 0. 8% (800 per 100, 000 DM patients)
Screening DM patients for TB BMI of ≥ 30 (AOR 23. 24; 95% CI 3. 98135. 77) Predictors of TB BMI of 25 -29. 9 (AOR 11. 83, 95% CI 3. 05 -45. 88). Smoker (AOR 36. 4; 95% CI 9. 33 -1 41. 85),
(From a previous study on prevalence of DM among TB patients in 2016) A total of 2094 TB patients were screened for DM Age ü 196 (9. 4%) TB patients were diagnosed with DM ü≤ 40 yrs: 1190 (56. 8%) ü> 40 yrs: 904 (43. 2%) 43. 6% 913 56. 4% 1181 üPredictors: Age >40 years (a. OR 2. 8, CI 2. 1– 3. 9) The study found a DM prevalence of 9. 4% among 2094 newly diagnosed TB patients screened in 13 health facilities, across 6 selected states (CRS, Ebonyi, Edo, Enugu, Ondo and Ogun) in southern Nigeria.
Prevalence of DM among Tuberculosis patients in southern Nigeria 9. 4% (9, 400 per 100, 000 TB patients)
Conclusion • The prevalence of TB was found to be higher among DM patients than in the general population. This was comparable to similar findings outside Nigeria. • Predictors of TB among DM patients were “cigarette smoking” and high body mass index (BMI).
Recommendations • NTBLCP and partners should plan and develop policy for Tuberculosis-Diabetes integrated services which will ultimately help mitigate the emerging DM/TB epidemic. • We recommend a national policy and implementation of routine bi-directional screening of TB and DM patients in line with the recommendations of the joint framework promoted by IUATLD and the World Health Organization. • Additionally, a nationwide survey on the prevalence and predictors of TB among DM patients is recommended.
Acknowledgement: DM/TB Facility Anchors & co-authors • Prof. Eruke E. Egbagbe, Pulmonologist, UBTH, Benin • Prof. Andrew Efosa Edo, Endocrinologist, UBTH, Benin • Dr. Adesina, Endocrinologist, FMC, Abeokuta • Dr. Victoria N Uwanuruochi, Endocrinologist, FMC, Umuahia • Dr. Festus Soyinka, Director Public Health, SMo. H, Abeokuta, Ogun • Dr. Ezechukwu Aniekwensi, Endocrinologist, FMC, Asaba • Dr. Miriam Ajuba, Public Health Physician, ESUTH, Enugu • Dr. Ekenechukwu E. Young, Endocrinologist, UNTH Enugu • Dr. Adenike C. Enikuomeyin, Endocrinologist, University of Medical Science Teaching Hospitals Complex, Akure • Dr. Adeyemi Ajayi, Sacred Heart Hospital, Lantoro, Abeokuta • Dr. Francis Bakpa, Central Hospital, Warri
THANK YOU
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