7th Call - Mr. David Nana Adjei

Project Title: Comorbid Conditions among Tuberculosis Patients: The Case of Diabetes in the Accra Metropolis

Principal Investigator: Mr. David Nana Adjei (Department of Medical Laboratory Sciences, University of Ghana)

Email Address: dnadjei@ug.edu.gh / dna@chs.edu.gh

Award Amount: GHC 4,940.00

Project Status: Final Report Submitted

Summary:

The global burden of diabetes mellitus (DM) and tuberculosis (TB) is huge. Nearly one-third of the world’s population is infected with Mycobacterium tuberculosis and about 10% of them are at risk of developing active form of the disease in their lifetime depending upon the interaction of the epidemiological triad (IDF, 2012; WHO, 2011). In 2011, the International Diabetes Federation (IDF) estimated that about 366 million people worldwide have diabetes mellitus (DM). Eighty percent (80%) of these people live in the low and middle income countries where tuberculosis (TB) is highly prevalent (IDF, 2012). According to the World Health Organisation (WHO), there were an estimated 8.8 million incident cases of TB globally in 2010 (WHO, 2011). Currently, both TB and DM are of great public health importance globally especially in Sub Saharan Africa (SSA) due to the converging epidemics of both communicable and non communicable diseases. Recent evidence advocates for bi-directional screening and care of TB and DM patients. This is because both morbidities adversely affect each other (Ottmani, Murray et al., 2010) and currently, there is plausible evidence from different studies to support the strong association between DM and TB (Faurholt-Jepsen, Range, PrayGod, et al., 2011). The idea that TB and DM share synergetic relationship has been creating growing concern around the world. Recently, WHO and the International Union Against Tuberculosis and Lung Disease (Union) have acknowledged the need for international guidelines on the joint management and control of TB and DM and have published a provisional collaborative framework for the care and control of both diseases (Goldhaber-Fiebert, Jeon, Cohen, Megan, 2011). Tuberculosis (TB) is a specific infectious disease caused by Mycobacterium tuberculosis. The disease is usually chronic with cardinal features like persistent cough with or without expectoration, intermittent fever, loss of appetite, weight loss, chest pain and haemoptysis (IDF, 2012). Tuberculosis is one of the three primary diseases of poverty along with AIDS and malaria (Goldhaber-Fiebert, Jeon, Cohen, Megan, 2011). A third of the world's population is thought to be infected with M. tuberculosis, and new infections occur at a rate of about one per second (Stevenson, Critchley, Forouhi, Roglic, Williams, et al., 2007). It is a disease of poverty affecting mostly young adults in their most productive years. The vast majority of TB deaths are in the developing world. Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year and this continues the TB transmission. Overall, one-third of the world’s population is currently infected with the TB bacillus. 5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. Currently, there is no documented evidence of any study to determine the prevalence of DM among TB patients. There is also a general paucity of data on current prevalence of TB in Ghana. A cross sectional study involving one hundred (100) clinically diagnosed TB patients and one hundred (100) clinically diagnosed diabetes patients above 18 years will be used in the study. Random blood sugar and other clinical factors of DM will tested for and compared in terms of associations. The findings of the study will enable the researcher determine the prevalence of DM in TB patients in the Accra Metropolis while using the finding to advocate for evidence based routine screening of DM amongst TB patients. Also, it is expected the control and management of this co-morbid condition can be effectively improved based on the findings of this study.

Findings

Preliminary results showed significant differences in the prevalence   of diabetes among TB patients compared with the general population (6.7% versus 3.8%; p-value=0.032).