Publication: Active tuberculosis case finding on diabetic patients attending diabetic outpatient clinic at JM Kariuki county hospital, Nyandarua county Kenya
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2022-09
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Mount Kenya University
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Abstract
Notwithstanding the concerted efforts to attain the objectives stipulated in tuberculosis
(TB) End Strategy by 2035, tuberculosis continues to be one of the principal healthcare
concerns globally. Tuberculosis- Diabetes comorbidity accelerates tuberculosis disease
and complicates treatment hence aggregating the possibility of poor tuberculosis
outcome. The principal objective of this study is to determine missed active tuberculosis
disease among diabetic patients enrolled in the outpatient diabetes management clinic at
JM Kariuki County Hospital, Nyandarua County. The study investigates the prevalence
of tuberculosis, estimates the positive yield of tuberculosis diagnosis by Gene Xpert, X ray and Fluorescent microscopy (FM) diagnostic methods, and explores the
socioeconomic factors of tuberculosis infection among patients with diabetes at JM
Kariuki County Hospital, Nyandarua. A sample size of 139 study participants was used
for the study. Data was collected through carrying out diagnostics tests which included:
Fluorescent TB smear microscopy, Gene-Xpert test, Chest X-ray, blood sugar test and
face to face interviews which was recorded in a structured interviewer checklist and the
clinical data uploaded in various ministry of health laboratory tools. SPSS version 22
was used to analyse the data. A high prevalence rate (2.66%) of missed tuberculosis
cases was recorded among diabetics. The results suggested Gene Xpert (with a positive
yield of 1.60%) as the test with the highest positivity yield in the diagnosis of
tuberculosis among diabetics at JM Kariuki County Hospital, Nyandarua. A notable
difference was noted in the prevalence of tuberculosis among different age groups of
participants (p = 0.001) suggesting strong statistical relationship between tuberculosis
infection and age, emphasizing the established association between tuberculosis and age
factor. A p-value of 0.613 suggested the existence of a weak association between the
gender of diabetic patients even though a significant statistical association was noted
between occupation and tuberculosis occurrence (p = 0.003). A significant statistical
association was noted to exist between smoking and alcoholism and tuberculosis
infection among diabetics (p = 0.001). The study proposes tuberculosis screening for all
new diabetes mellitus (DM) incidences when resources allow, and prioritized screening
using chest x-ray for diabetes mellitus patients and gene expert analysis for people who
have suggestive symptoms and patients aged 40 above, as well as those engaging in
behaviours such as habitual alcohol consumption and cigarette smoking. Additional
focus is recommended for tuberculosis infections in the lower lobes of the lungs, since
lower lung involvement is one of the common features of tuberculosis infection among
people with diabetes mellitus. Patients suffering from both diabetes mellitus and
tuberculosis face higher chances of presenting cavitation, smear-positivity during
diagnosis, and they may continue being culture positive 8 weeks after the onset of the
treatment plan. Additional diagnostic initiative that focuses on continuous monitoring of
serum drug concentration and ensuring that the tuberculosis therapy dosage is enough is
recommended to enable a sustained advancement of the patient towards tuberculosis
eradication. As such, the findings of this study emphasize the need to incorporate active
tuberculosis case finding in diabetes mellitus management in Nyandarua County, as a
milestone towards the enhancement of the national tuberculosis strategy.
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Keywords
Tuberculosis, Diabetic, Diabetic patients