Main Article Content
Introduction: Tuberculosis (TB) continues to rank high in contributing to the global disability adjusted life years with 10 million new cases yearly worldwide. Having effective control of TB particularly in endemic communities should be predicated on understanding factors that drive its upsurge.
Objectives: This study assessed the association between socio-demographic factors and nutritional status among adults with pulmonary TB in Calabar, Nigeria.
Methods: A descriptive analysis of a randomized controlled study that enrolled 81 clinically diagnosed pulmonary TB patients that met the eligibility criteria. Data assessed were, socio-demographic, clinical, dietary, anthropometric, haematological and serum concentration of micronutrients. Results were presented in frequencies, percentages, tables and chart. Chi-square (ꭕ2) test was used to determine existence of associations between variables at 5% level, while, Pearson Correlation test was applied to determine the correlation between variables. P-value was used to determine significance of tests.
Results: Using body mass index (BMI) as a proxy of nutritional status, results indicate that 33.4% of patients were undernourished with no discernible gender differences (p=0.254). Income level classification was observed to be statistically significantly associated with undernutrition (p=0.021), with those in the low-income category most at risk. Correlation analysis of key variables indicated that low serum ascorbate, zinc and retinol were independently associated with low BMI. These associations were statistically significant (p<0.05).Singleness was identified as a risk factor for undernutrition (p=0.060). Low functional status proxied by Karnofsky score <50% tended to align more with patients in the low income level category.
Conclusion: Results consistently indicate that patients in the low income category had higher proportion of lower ranges of haemoglobin, protein parameters, serum ascorbate, zinc and retinol concentrations considered deficient. Thus, poverty alleviation strategies should be highly prioritized in TB programming for effective control.
WHO: Global nutrition policy review: What does it take to scale up nutrition actions? World Health Organization; Geneva; 2013. ISBN 978 92 4 150552 9.
WHO. Global Tuberculosis Report 2018. Geneva: World Health Organization; 2018. Licence: CCBY-NC-SA 3.0 IGO.
Bacelo AC, Ramalho A, Brasil PE, Cople-Rodrigues CD, Georg I, Paiva E, Argolo SV, Rolla VC. Nutritional supplementation is a necessary complement to dietary counseling among tuberculosis and tuberculosis-HIV patients. Plos 1. 2015; 10(8):e0134785. Available:https://doi.org/10.1371/journal.pone.0134785
Chaulk CP, Kazandjian VA. Evaluation of evidence on relative effectiveness of DOTS in achieving treatment for pulmonary tuberculosis. Journal of American Medical Association. 1998;297: 943-948.
WHO. Laboratory services and contact investigations in tuberculosis control: Risk assessment. Global Tuberculosis Programme. Geneva: World Health Organisation; 2001.
Ruxin J. Paluzzi JE, Wilson PA, Tozan Y, Kruk M, Teklehaimanot A. Emerging concensus in HIV/AIDS, malaria, tuberculosis, and access to essential medicines. The Lancet. 2005;365:618-621. DOI:10.1016/S0140-6736(05)17914-8
Sorlie DP, Backlaud E, Keller BJ. US mortality by economic, demographic, and social characteristics: The national longitudinal mortality study. American Journal of Public Health. 1995;85(7):949-956.
CSDH. Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health (CSDH). Geneva, World Health Organization; 2008.
Orege PA, Obura M, Okello C, Were M. Socio economic risk factors in the association between tuberculosis and HIV infection in a rural community in Kenya. International Conference on AIDS, Abstract. 1993;6-11:9:673.
Gupta D, Das K, Balamughesh T, Aggarwal AN, Jindal SK. Role of socioeconomic factors on Tuberculosis prevalence. Indian Journal of Tuberculosis. 2004;51:27-31. Available:www.researchgate.net/publication/249991067
Lienhardt C, Fielding K, Sillah JS, Bah B, Gustafson P, Warndorff D. Investigation of the risk factors for tuberculosis: A case-control study in three countries in West Africa. International. Journal of Epidemiology. 2005;34:914-923.
Pakasi TA, Karyadi E, Dolmans WM, van der Meer JW, van der Velden K. Malnutrition and socio-demographic factors associated with pulmonary turberclosis in Timor and Rote Islands, Indonesia. International Journal of Tubercle Lung Diseases. 2009;13(6):755–759.
Gupta KB, Gupta R, Atreja A, Verma M, Vishvkarma S. Tuberculosis and nutrition; Lung India. 2009;26:9-16.
Chakraborty S, Syal K, Bhattacharyya R, Banerjee D. Vitamin deficiency and tuberculosis: Need for urgent clinical trial for managment of tuberculosis. J Nutrition Health Food Sci. 2014;2(2):1-6.
Zhuang LS, Ling LK, Xu BS, Yuan ZZ. Adjuvant efficacy of nutrition support during pulmonary tuberculosis treating course: Systematic review and meta-analysis. Chinese Medical Journal. 2015; 128(23):3219-3230.
Attah CJ, Oguche S, Egah D, Ishaya TN, Banwat M, Adgidzi AG. Risk factors associated with paediatrics tuberculosis in endemic setting. Alexandria Journal of Medicine. 2018;54:403-409.
Ejemot-Nwadiaro RI, Itam EH, Ezedinachi EN. Zinc supplementation as adjunctive therapy in adults with tuberculosis in Calabar, Nigeria: A randomized controlled trial. Journal of Advances in medicine and Medical Research. 2019;29(4):1-13.
Ejemot-Nwadiaro RI. A guide to biostatistics and health research methods. DataPro Publishers, Calabar; 2009.
Schag CC, Heinrich RL, Ganz P. Karnofsky performance status revisited: Reliability, validity, and guidelines. Journal of Clinical Oncology. 1984;2:187-193.
Chawla R. Practical clinical biochemistry: Methods and interpretations (2nded.). Bangalore: JAYPEE Brothers Medical Publishers Ltd; 1999.
Onwubalili JK. Malnutrition among tuberculosis patients in Harrow, England. European Journal Clinical Nutrition. 1988;42(4):363-366. Available:https://europepmc.org/artictle/med/3396528
Van Lettow M, Harries AD, Kumwenda JJ, Zijlstra EE, Clark TD, Taha TE, Semba RD. Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis with and without HIV-co-infection in Malawi. BioMed Central (BMC) Infectious Disease. 2004;4:61-69. Available:https://doi.org/10.1186/1471-2334-4-61
Shetty N, Shemko M, Vaz M, D’Souza G. An epidemiological evaluation of risk factors for tuberculosis in South India: A matched case control study. International Journal of Tubercle Lung Diseases. 2006;10(1):80–86. Available:https://www.ingentaconnect.com
Nordin SM, Boyle M, Kemmer TM. Position of the academy of nutrition and dietetics (AND): Nutrition security in developing nations: Sustainable food, Water and Health. Journal of the Academy of Nutrition and Dietetics. 2013;113(4):581-595.
Guadie FF, Assaminew B. Assessment of nutritional status and associated factors among adult TB patients on Directly Observed Treatment Short-course in health facilities of Adama Town, East Shewa Zone, Ethiopia. International Journal of Interdisciplinary Studies in Business, Technology & Education. 2017;1(1); ICIRS Conferences.
Dargie B, Tesfaye G, Worku A. Prevalence and associated factors of undernutrition among adult tuberculosis patients in some selected public health facilities of Addis Ababa, Ethiopia: A cross-sectional study. BMC Nutrition; 2016.
Ebuehi OM, Sotunde OM, Chinda GN, Oyetoyan SA, Ebuehi OAT. Nutrition knowledge, attitude, practice and assessment of nutritional status of tuberculosis patients attending selected DOTS clinics in Lagos State, Nigeria. Nigerian Quarterly Journal of Hospital Medicine. 2013;23(3).
Scrimshaw NS, Sangiovanni JP. Synergism of nutrition, infection and immunity: An overview. American Journal of Clinical Nutrition. 1997;66:464S-477S. Available:https://academic.oup.com/ajcn/article-abstract/66/2464S/4655772
Ketiku A, Ejemot RI, Fasanmade A. The relationship between anti-oxidants and blood lipids in diabetes mellitus. African Journal of Biomedical Research. 1999;2: 177-122. Available:www.ajol.info/index.php/ajbr/article/view
Oguntibeju OO, van den Heever WMJ, Van Schalkwyk FE. The interplay between socio-demographic variables, nutritional and immune status of HIV-positive/AIDS patients. Pakistan Journal of Biological Sciences. 2007;10:3592-3598.
Davies PDO, Grange JM. Factors affecting susceptibility and resistance to tuberculosis. Thorax. 2001;56:23-29.
Dai H, Phalen S, McMurray DN. Nutritional modulation of host response to mycobacteria. Front Biosciences. 1998;3: 110–122. Available:https://www.fbsserver.org
Akhtar S, White F, Hasan R, Rozi S, Younus M, Ahmed F, Husain S, Khan BS. Hyperendemic pulmonary TB in Peri-urban areas of Karachi, Pakistan. BMC Public Health. 2007;7:70-80.
Asuquo A, Abia-Bassey L, Thumamo B, Osuchukwu N, Ejemot-Nwadiaro RI, Oyo-Ita A, Meremikwu M. Demography and living conditions of tuberculosis patients receiving directly observed therapy short-course (DOTS) in Calabar, Nigeria. Global Journal of Medical Sciences. 2008; 7(1&2):45-50.
Etim KD, Ejemot-Nwadiaro RI, Kalu RE. A study of malnutrition-dependent factors among under-five children in Ekureku community, Abi Local Government Area of Cross River State, Nigeria. British Journal of Medicine & Medical Research. 2017; 21(8):1 -10.
Hu Y, Goldman N. Mortality differentials by marital status: An international comparison. Demography. 1990;27:233-250.
Ikeda A, Iso H, Toyoshima H, Fujino Y, Mizoue T, Yoshimura T. Marital status and mortality among Japanese men and women: The Japan collaborative cohort study. Bio Med Central (BMC) Public Health. 2007;7:73
Wyke S, Ford G. Competing explanations for associations between marital status and health. Social Science and Medicine. 1992;34(5):523-532. Available:https://doi.org/10.1016/0277-9536(92)90208-8. Available:https://www.sciencedirect.com