Prevalence and associated factors for Alcohol Use Disorder among tuberculosis patients: A systematic review and meta-analysis study.

Abstract

Background: Alcohol use disorders (AUD) in tuberculosis patients are complicated with poor compliance to anti-tuberculosis treatment and poor tuberculosis treatment outcomes. However, aggregate data concerning this problem is not available. Therefore, this review aimed to fill the above gap by generating an average prevalence of AUD in tuberculosis patients.Method: Our electronic search for original articles was conducted in the databases of Scopus, PubMed, and EMBASE, African Index Medicus, and psych-info. Besides, the reference list of selected articles was looked at manually to have further eligible articles for the prevalence and associated factors of AUD in tuberculosis patients. The random-effects model was employed during the analysis. MS-Excel was used to extract data and stata-11 to determine the average prevalence of AUD among tuberculosis patients. A sub-group analysis and sensitivity analysis were also run. A visual inspection of the funnel plots and an Eggers publication bias plot test were checked for the presence of publication bias.Result: A search of the electronic and manual system resulted in 1970 articles. However, after removing duplicates and unoriginal articles, only 28 articles that studied 30854 tuberculosis patients met the inclusion criteria. The average estimated prevalence of AUD in tuberculosis patients was 30% (95% CI: 24.00, 35.00). This was with a slight heterogeneity (I2 = 57%, p-value < 0.001). The prevalence of AUD in tuberculosis patients was higher in Asia and Europe; 37% than the prevalence in the US and Africa; 24%. Besides, the average prevalence of AUD was 39%, 30%, 30%, and 20% in studies with case-control, cohort, cross-sectional and experimental in design respectively. Also, the prevalence of AUD was higher in studies with the assessment tool not reported (36%) than studies assessed with AUDIT. AUD was also relatively higher in studies with a mean age of ≥ 40 years (42%) than studies with a mean age < 40 years (24%) and mean age not reported (27%). Based on a qualitative review; the male gender, older age, being single, unemployment, low level of education and income from socio-demographic variables, retreatment and treatment failure patients, stigma, and medication non-adherence from clinical variables were among the associated factors for AUD. Conclusion: This review study obtained a high average prevalence of AUD in tuberculosis patients and this varies across continents, design of studies, mean age of the participants, and assessment tool used. This implied the need for early screening and management of AUD in tuberculosis patients.

Psychiatric morbidity among patients on treatment for tuberculosis at a tertiary referral hospital in Western Kenya

“…Males were more likely to have 'any' psychiatric illness or alcohol and substance use disorders, similar to findings of a meta-analysis [15] and several other studies in Africa and Asia [16][17][18]45]. Culturally, social drinking among men is more tolerated compared to the same in females while it could be the start or gateway to alcohol or substance use disorders.…”

“…The assessed prevalence of alcohol use disorder is similar to a pooled average of 30% in a meta-analysis of 28 studies in tuberculosis patients [15], but double that previously reported for the general Kenyan population at 13.6% [37]. There's a strong association between heavy alcohol use and TB as alcohol weakens the immune system by interfering with the integrity and microbiomes of the gastrointestinal tract, decreasing and damaging the epithelial cells and by disruption of the ciliary function of the upper airways thus ultimately increasing the risk of TB [38].…”

“…Van Rensburg et al in a systematic review of 100 articles also reported similar results [7]. A meta-analysis, however, reported that respondents who were single had higher odds of alcohol use disorder [15]. Those who are single, separated or divorced may lack good social support and may be at higher risk of maladaptive coping including alcohol use while on the other hand addiction may lead to change in marital status [28].…”

“…There's a strong association between heavy alcohol use and TB as alcohol weakens the immune system by interfering with the integrity and microbiomes of the gastrointestinal tract, decreasing and damaging the epithelial cells and by disruption of the ciliary function of the upper airways thus ultimately increasing the risk of TB [38]. Heavy alcohol use has been linked to higher reinfection rate, poor treatment compliance and development of drug resistant TB [15]. Also people with chronic alcohol use often have poor nutritional status predisposing to activation of latent TB [3].…”

“…A study from Kenya, found a prevalence of depression at 31% among 51 TB patients [14]. Studies in Zambia, Thailand and India of patients on treatment for TB found a range of 20% -30% for alcohol use disorder [15][16][17][18] while substance use disorder ranged from 3%-39% in Pakistan, Peru and Ethiopia [19][20][21]. Prevalence of mental illness varies depending on region and screening tool used but is higher when compared to that in the general population [22][23][24].…”