Screening for diabetes mellitus among tuberculosis patients in Southern Nigeria: a multi-centre implementation study under programme settings

Ekeke, Ngozi; Ukwaja, Kingsley Nnanna; Chukwu, Joseph N.; Nwafor, Charles C.; Meka, Anthony O.; Egbagbe, Eruke E.; Soyinka, Festus Olukayode; Alobu, Isaac; Agujiobi, Ifeanyi; Akingbesote, Samuel; Igbinigie, Osagie; Offor, Job B.; Madichie, Nelson O.; Alphonsus, Chukwuka; Anyim, Moses C.; Mbah, Obinna; Oshi, Daniel C.

doi:10.1038/srep44205

Cited by 28 publications

(29 citation statements)

References 26 publications

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“…We observed that HIV sero-negative TB patients were more likely to have DM compared to those who were HIV sero-positive. Similar findings have been reported in other studies in SSA [19, 26, 33]. However, published reports on association between HIV and diabetes have not been consistent.…”

Section: Discussionsupporting

confidence: 90%

Diabetes mellitus among patients attending TB clinics in Dar es Salaam: a descriptive cross-sectional study

2019

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BackgroundA bi-directional interaction between diabetes mellitus and tuberculosis is well established and has been likened to that between HIV and TB. Whereas HIV screening is standard of care test in sub Saharan Africa TB programs, the same is not true for diabetes mellitus (DM). Sub Saharan Africa, a region with high TB infection rates, is going through an epidemiological transition with rapidly rising prevalence of diabetes.We aimed at characterizing TB patients with DM in order to identify factors associated with TB-DM dual disease among patients attending TB clinics in Dar es Salaam.MethodsA cross-sectional study was conducted between September 2016 and January 2017 among patients attending TB clinics in Dar es Salaam. We collected socio-demographic characteristics, anthropometric measurements and screened for diabetes by measuring fasting blood glucose that was followed by a 2 h postprandial glucose for participants with impaired fasting blood glucose. We examined for socio-demographic and clinical factors associated with diabetes using logistic regression analysis.ResultsOf the 660 enrolled participants with TB, 25 (3.8%) were on treatment for diabetes while 39 (6.1%) and 147 (23%) of the remaining 635 participants were ultimately diagnosed with DM and impaired fasting blood glucose respectively. The overall prevalence of DM was 9.7% (64/660). Independent risk factors for diabetes included: age > 44 years {OR 4.52, 95% CI: [1.28–15.89]}; family history of diabetes {OR 3.42, 95% [CI 1.88–6.21]}.HIV sero-positive TB patients were less likely to have DM compared to those who were HIV sero-negative {OR 0.35, 95% CI [0.17–0.73]}.ConclusionsScreening for diabetes should be advocated for TB patients aged above 44 years and/or with a family history of diabetes. HIV sero-negative TB patients were more likely to have DM compared to those who were HIV sero-positive. Further studies are needed to confirm this observation and the underlying factors.

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Section: Discussionsupporting

confidence: 90%

Diabetes mellitus among patients attending TB clinics in Dar es Salaam: a descriptive cross-sectional study

2019

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“…The aim of this research was to explore the barriers and facilitators to bidirectional screening in healthcare facilities in the Northern Region of Ghana. This study found that implementing bidirectional screening in public health facilities was achievable, when properly implemented, which is consistent with the findings of similar studies [6,22,23]. An increase in staff capacity and institutionalization of bidirectional screening were found to be enablers to the screening process, while delays in screening, fear and stigmatization of TB, poor collaboration between TB and DM units, and skewed funding for screening, were all found to hinder the successful implementation of bidirectional screening in the healthcare facility setting in the Northern Region of Ghana.…”

Section: Discussionsupporting

confidence: 92%

Barriers and facilitators to bidirectional screening of TB-DM in Ghana: Healthcare workers’ perspectives

Salifu

Hlongwana

2020

PLoS ONE

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Background The tuberculosis (TB) and diabetes mellitus (DM) co-epidemic continues to increase globally. Low-and middle-income countries bear the highest burden of co-epidemic, and Ghana is no exception. In 2011, the World Health Organisation (WHO) responded to this global challenge by launching a collaborative framework with a view to guide countries in implementing their DM and TB care, prevention and control plans. Subsequently, several countries, including Ghana, adopted this framework and began implementing bidirectional screening of TB and DM patients. Almost a decade later since the launch of the framework, the implementation of bidirectional screening in Ghana has not been subjected to empirical research. This study explored the barriers and facilitators to bidirectional screening through the lenses of the implementing healthcare workers. Methods This was an exploratory qualitative study conducted in three public health facilities offering both TB and DM services in Northern Ghana. In-depth interviews, document review and observations, were used to generate data. In total twenty-three healthcare workers (doctors, nurses, prescriber, health managers and TB task-shifting officers delivering care in TB and DM clinics) were interviewed, using semi-structured interview guides. The interview questions solicited information on the screening process, including knowledge of the collaborative framework, comorbidity, collaboration and workload. Results Six themes emerged from the analysis, of which two (Increase in staff capacity, and Institutionalisation of bidirectional screening) were facilitators, and four (Delays in screening, Fear and stigmatization of TB, Poor collaboration between TB and DM units, and Skewed funding for screening) were barriers.

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“…A link between TB and DM has been shown in several literature, and diabetes triples the risk of TB [2,3,5]. TB and DM pose a serious threat to people of all ages and their co-infection involves more 3 complications [6,25,7,8], resulting in significant health challenges. The World Health Organization (WHO) and the International Union against Tuberculosis and Lung Disease have long argued for TB and Diabetes care to be integrated in response to their risk [9,15,10,11,12].…”

Section: Introductionmentioning

confidence: 98%

Assessment of the Implementation of Tuberculosis and Diabetes Care in health systems: A Situational Analysis in Western Nigeria for consideration

Peter

Aighobahi.

2019

Preprint

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Background: Tuberculosis (TB) coexists with other non-communicable diseases (NCDs), including Diabetes Mellitus (DM). Smoking increases the risk of TB as well as DM. Health systems are poorly prepared in many low middle income countries (LMICs) and are currently facing the "triple burden of smoking, TB, and DM" that drives these countries into the vicious cycle of poverty. Methods: A cross-sectional study method was carried out to assess the proportion of TB care centers that included integration measures for diabetic care as well as those providing DM care that included integration measures for TB. A list of 49 health care centers in Lagos offering TB care and managing Diabetes patients were recruited. A focus Group Discussion(FGD) and Individual interviews were conducted to investigate health care providers ' knowledge, attitudes and practices and the barriers encountered in the process of integrating TB and DM care. Results: Out of the 49 health care centres recruited in this study, 6% of health care units are aware of a surveillance to screen for diabetes in tuberculosis patients, while 2% of health facilities confirmed awareness of a surveillance to screen for tuberculosis in diabetes patients. 91% of health centres either verified the lack of or no understanding of monitoring of both diseases. The percentage of health facilities that have existing guideline on TB and DM screening was evaluated, it was perceived that 8% of health facilities had implemented a guideline to screen for DM in TB patients, while 4% of these Care Centres have implemented a guideline for diabetes patients to be screened for TB. Conclusion TB/DM integrative screening, treatment and management could be better attained if both co-morbidities integration program is initiated in the healthcare centres and policies of western states and Nigeria as a whole.

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Screening for diabetes mellitus among tuberculosis patients in Southern Nigeria: a multi-centre implementation study under programme settings

Cited by 28 publications

References 26 publications

Diabetes mellitus among patients attending TB clinics in Dar es Salaam: a descriptive cross-sectional study

Diabetes mellitus among patients attending TB clinics in Dar es Salaam: a descriptive cross-sectional study

Barriers and facilitators to bidirectional screening of TB-DM in Ghana: Healthcare workers’ perspectives

Assessment of the Implementation of Tuberculosis and Diabetes Care in health systems: A Situational Analysis in Western Nigeria for consideration

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