Prevalence of Tuberculosis Risk Factors among Bacteriologically Negative and Bacteriologically Confirmed Tuberculosis Patients from Five Regional Referral Hospitals in Uganda

Winters Muttamba Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda;

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Bruce Kirenga Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda;

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Willy Ssengooba Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda;

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Rogers Sekibira Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda;

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Achilles Katamba School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda

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Moses L. Joloba Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda;

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DOI:
https://doi.org/10.4269/ajtmh.18-0281
Volume/Issue:
Volume 100: Issue 2
Page(s):
386–391
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Understanding risk factors for tuberculosis (TB) and their prevalence helps guide early diagnosis. We determined their prevalence among bacteriologically negative and bacteriologically confirmed TB patients in five regional referral hospitals in Uganda. This cross-sectional study considered 1,862 adult presumptive TB participants. We performed fluorescent microscopy, Xpert MTB/RIF (Xpert), Lowenstein–Jensen culture, human immunodeficiency virus, and random blood sugar testing on recruited patients. Prevalence and prevalence ratios of risk factors were compared among bacteriologically negative and confirmed cases. Odds ratios and 95% confidence interval (CI) were determined for significant risk factors in bacteriologically confirmed patients. Of the 1,862 participants, 978 (55%) were male and the median age of the participants was 36 years (interquartile range: 27–48). Up to 273 (15%) had a positive result on all three TB tests. Most prevalent risk factors (prevalence ratio [PR] > 1.0) among bacteriologically negative and positive TB patients were cigarette smoking (9.3% versus 2.1%; PR = 2.1), biosmoke (24% versus 39.7%; PR = 1.7), contact (4.2% versus 6.5%; PR = 1.6), male gender (51.4% versus 72.5%; PR = 1.4), alcohol use (17.2% versus 24.4%; PR = 1.4), diabetes (0.7% versus 0.9%; PR = 1.3), and family history of TB (12.1% versus 13.7%; PR = 1.1). The risk factors and their adjusted prevalence rate ratios (95% CI) of being bacteriologically positive were male (1.8 [1.4–2.4]), biosmoke exposure (1.5 [1.2–2.0]), and history of cigarette smoking (1.6 [1.1–2.4]). Among bacteriologically confirmed patients in Uganda, cigarette smoking, biosmoke exposure, contact, male gender, alcohol use, diabetes, and family history of TB are important risk factors for TB. Interventions for TB control in people with these risk factors would help in TB control efforts.

Author Notes

Address correspondence to Winters Muttamba, Makerere University Lung Institute, College of Health Sciences, Makerere University, P.O. Box 7749, Kampala, Uganda. E-mail: muttamba@gmail.com

Financial support: This study was conducted with funding from the World Bank under the East African Public Health Laboratory Networking Project (EAPHLNP).

Authors’ addresses: Winters Muttamba, Bruce Kirenga, and Rogers Sekibira, Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda, E-mails: muttamba@gmail.com, brucekirenga@yahoo.co.uk, and sekibira@gmail.com. Willy Ssengooba and Moses L. Joloba, Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda, E-mails: willyssengooba@gmail.com and m.joloba@gmail.com. Achilles Katamba, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda, E-mail: akatamba@yahoo.com.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2019
Received:
03 Apr 2018
|
Accepted:
04 Sep 2018
|
Published Online:
26 Dec 2018
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 1.

    World Health Organization, 2015. Global Tuberculosis Report 2015. Geneva, Switzerland: WHO.

  • 2.

    World Health Organization, 2017. Tuberculosis Patient Cost Surveys: A Handbook. Geneva, Switzerland: WHO.

  • 3.

    Narasimhan P, Wood J, MacIntyre CR, Mathai D, 2013. Risk factors for tuberculosis. Pulm Med 2013: 828–939.

  • 4.

    Davies P, 2005. Risk factors for tuberculosis. Monaldi Arch Chest Dis 63: 37–46.

  • 5.

    Lienhardt C, Fielding K & Sillah J et al. 2005. Investigation of the risk factors for tuberculosis: a case–control study in three countries in West Africa. Int J Epidemiol 34: 914–923.

    • Search Google Scholar
    • Export Citation
  • 6.

    Shetty N, Shemko M, Vaz M, D’Souza G, 2006. An epidemiological evaluation of risk factors for tuberculosis in South India: a matched case control study. Int J Tuberc Lung Dis 10: 80–86.

    • Search Google Scholar
    • Export Citation
  • 7.

    Lönnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M, 2009. Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc Sci Med 68: 2240–2246.

    • Search Google Scholar
    • Export Citation
  • 8.

    Lienhardt C, Fielding K, Sillah J, Tunkara A, Donkor S, Manneh K, Warndorff D, McAdam KP, Bennett S, 2003. Risk factors for tuberculosis infection in sub-Saharan Africa: a contact study in the Gambia. Am J Respir Crit Care Med 168: 448–455.

    • Search Google Scholar
    • Export Citation
  • 9.

    Coker R, McKee M, Atun R, Dimitrova B, Dodonova E, Kuznetsov S, Drobniewski F, 2006. Risk factors for pulmonary tuberculosis in Russia: case-control study. BMJ 332: 85–87.

    • Search Google Scholar
    • Export Citation
  • 10.

    Viswanathan V, Kumpatla S, Aravindalochanan V, Rajan R, Chinnasamy C, Srinivasan R, Selvam JM, Kapur A, 2012. Prevalence of diabetes and pre-diabetes and associated risk factors among tuberculosis patients in India. PLoS One 7: e41367.

    • Search Google Scholar
    • Export Citation
  • 11.

    Stevenson CR, Critchley JA, Forouhi NG, Roglic G, Williams BG, Dye C, Unwin NC, 2007. Diabetes and the risk of tuberculosis: a neglected threat to public health? Chronic Illn 3: 228–245.

    • Search Google Scholar
    • Export Citation
  • 12.

    Zolopa AR, Hahn JA, Gorter R, Miranda J, Wlodarczyk D, Peterson J, Pilote L, Moss AR, 1994. HIV and tuberculosis infection in San Francisco’s homeless adults: prevalence and risk factors in a representative sample. JAMA 272: 455–461.

    • Search Google Scholar
    • Export Citation
  • 13.

    Kirenga BJ, Ssengooba W, Muwonge C, Nakiyingi L, Kyaligonza S, Kasozi S, Mugabe F, Boeree M, Joloba M, Okwera A, 2015. Tuberculosis risk factors among tuberculosis patients in Kampala, Uganda: implications for tuberculosis control. BMC Public Health 15: 13.

    • Search Google Scholar
    • Export Citation
  • 14.

    Muttamba W, Ssengooba W, Sekibira R, Kirenga B, Katamba A, Joloba M, 2018. Accuracy of different Xpert MTB/Rif implementation strategies in programmatic settings at the regional referral hospitals in Uganda: evidence for country wide roll out. PLoS One 13: e0194741.

    • Search Google Scholar
    • Export Citation
  • 15.

    Weller C, 2017. The World Bank Released New Poverty Lines—Find Out Where Your Country Stands. Available at: https://www.businessinsider.com/world-bank-released-new-poverty-lines-see-where-your-country-falls-2017-10?IR=T. Accessed March 29, 2018.

  • 16.

    Mishra VK, Retherford RD, Smith KR, 1999. Biomass cooking fuels and prevalence of tuberculosis in India. Int J Infect Dis 3: 119–129.

  • 17.

    Fullerton DG, Bruce N, Gordon SB, 2008. Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans R Soc Trop Med Hyg 102: 843–851.

    • Search Google Scholar
    • Export Citation
  • 18.

    Perez-Padilla R, Perez-Guzman C, Baez-Saldana R, Torres-Cruz A, 2001. Cooking with biomass stoves and tuberculosis: a case control study. Int J Tuberc Lung Dis 5: 441–447.

    • Search Google Scholar
    • Export Citation
  • 19.

    World Health Organization, 2018. Uganda: WHO and UNICEF Estimates of Immunization Coverage: 2017 Revision. Available at: http://www.who.int/immunization/monitoring_ surveillance/data/uga.pdf. Accessed March 24, 2018.

  • 20.

    New Vision, 2016. Uganda Ranks Low in Immunisation Coverage-Report. Available at: http://www.newvision.co.ug/new_vision/news/1419452/uganda-ranks-low-immunisation-coverage-report. Accessed March 24, 2017.

  • 21.

    Sterne J, Rodrigues L, Guedes I, 1998. Does the efficacy of BCG decline with time since vaccination? Int J Tuberc Lung Dis 2: 200–207.

  • 22.

    World Health Organization, 2017. Global Tuberculosis Report. Geneva, Switzerland: WHO. Available at: http://www.who.int/tb/publications/global_report/gtbr2017_main_text.pdf?ua=1. Accessed March 23, 2017.

    • Search Google Scholar
    • Export Citation
  • 23.

    Kolappan C, Gopi P, 2002. Tobacco smoking and pulmonary tuberculosis. Thorax 57: 964–966.

  • 24.

    Leung CC, Li T, Lam TH, Yew WW, Law WS, Tam CM, Chan WM, Chan CK, Ho KS, Chang KC, 2004. Smoking and tuberculosis among the elderly in Hong Kong. Am J Respir Crit Care Med 170: 1027–1033.

    • Search Google Scholar
    • Export Citation
  • 25.

    Den Boon S, Van Lill S, Borgdorff M, Verver S, Bateman ED, Lombard CJ, Enarson DA, Beyers N, 2005. Association between smoking and tuberculosis infection: a population survey in a high tuberculosis incidence area. Thorax 60: 555–557.

    • Search Google Scholar
    • Export Citation
  • 26.

    Davies P, Yew W, Ganguly D, Davidow AL, Reichman LB, Dheda K, Rook GA, 2006. Smoking and tuberculosis: the epidemiological association and immunopathogenesis. Trans R Soc Trop Med Hyg 100: 291–298.

    • Search Google Scholar
    • Export Citation
  • 27.

    Altet-Gomez M, Alcaide J, Godoy P, Romero MA, Hernández del Rey I, 2005. Clinical and epidemiological aspects of smoking and tuberculosis: a study of 13038 cases. Int J Tuberc Lung Dis 9: 430–436.

    • Search Google Scholar
    • Export Citation
  • 28.

    Doll R, 1991. Urban and rural factors in the aetiology of cancer. Int J Cancer 47: 803–810.

  • 29.

    Lönnroth K, Williams BG, Stadlin S, Jaramillo E, Dye C, 2008. Alcohol use as a risk factor for tuberculosis–a systematic review. BMC Public Health 8: 1.

    • Search Google Scholar
    • Export Citation
  • 30.

    Rehm J, Samokhvalov AV, Neuman MG, Room R, Parry C, Lönnroth K, Patra J, Poznyak V, Popova S, 2009. The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review. BMC Public Health 9: 1.

    • Search Google Scholar
    • Export Citation
  • 31.

    Mathew TA, Yanov SA & Mazitov R et al. Tomsk Tuberculosis Alcohol Working Group 2009. Integration of alcohol use disorders identification and management in the tuberculosis programme in Tomsk Oblast, Russia. Eur J Public Health 19: 16–18.

    • Search Google Scholar
    • Export Citation
  • 32.

    Fiske CT, Hamilton CD, Stout JE, 2008. Alcohol use and clinical manifestations of tuberculosis. J Infect 57: 385–391.

  • 33.

    Central Intelligence Agency (CIA), 2017. World Fact Book. Available at: https://www.cia.gov/library/publications/the-world-factbook/fields/2046.html. Accessed August 22, 2016.

  • 34.

    Singh M, Mynak M, Kumar L, Mathew JL, Jindal SK, 2005. Prevalence and risk factors for transmission of infection among children in household contact with adults having pulmonary tuberculosis. Arch Dis Child 90: 624–628.

    • Search Google Scholar
    • Export Citation
  • 35.

    Hill PC, Jackson-Sillah D, Donkor SA, Otu J, Adegbola RA, Lienhardt C, 2006. Risk factors for pulmonary tuberculosis: a clinic-based case control study in the Gambia. BMC Public Health 6: 1.

    • Search Google Scholar
    • Export Citation
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