Smear positive pulmonary tuberculosis and associated factors among homeless individuals in Dessie and Debre Birhan towns, Northeast Ethiopia

Abstract

BackgroundTuberculosis (TB) remains one of the globe’s deadliest communicable diseases. The homeless individuals are at high risk to acquire TB and multi-drug resistant TB (MDR-TB), because of their poor living conditions and risky behaviors. Tuberculosis and MDR-TB in the homeless individuals can pose a risk to entire communities. However, the magnitude of the problem is not known in Ethiopia. Therefore, the aim of this study was to determine the prevalence and associated factors of smear positive pulmonary TB (PTB) and MDR-TB among homeless individuals in Dessie and Debre Birhan towns, Northeast Ethiopia.MethodsA community based cross-sectional study design was conducted from September 2014 to June 2015. Using an active screening with cough of ≥2 weeks, 351 TB suspects homeless individuals were participated in this study. Data were collected by using pre-tested and structured questionnaire. Spot-morning-spot sputum sample was collected and examined for acid-fast bacilli (AFB) using fluorescence microscopy by Auramine O staining technique. All AFB positive sputum was further analyzed by GeneXpert for detection of Mycobacterium tuberculosis complex and rifampicin resistant gene. Univariate and multivariate logistic regressions were applied to identify factors associated with smear positive PTB and P value <0.05 was considered as statistically significant.ResultsThe prevalence of smear positive PTB was 2.6 % (95 % CI 1.3–5) among TB suspect homeless individuals. Extrapolation of this study finding implies that there were 505 smear positive PTB per 100,000 homeless individuals. All smear positive PTB sputum specimens were further analyzed by GeneXpert assay, the assay confirmed that all were positive for MTBC but none were resistant to RIF or MDR. Smoking cigarette regularly for greater than 5 years (AOR 10.1, 95 % CI 1.1, 97.7), body mass index lower than 18.5 (AOR 6.9, 95 % CI 1.12, 41.1) and HIV infection (AOR 6.8, 95 % CI 1.1, 40.1) were significantly associated with smear positive PTB.ConclusionThe prevalence of smear positive PTB among TB suspect homeless individuals was 2.6 %. Among smear positive PTB, prevalence of HIV co-infection was very high 5 (55.5 %). Smoking cigarette regularly for greater than 5 years, BMI lower than 18.5 and HIV infection were factors associated with smear positive PTB. Special emphasis is needed for homeless individuals to exert intensive effort to identify undetected TB cases to limit the circulation of the disease into the community.

Health problems and healthcare service utilisation amongst homeless adults in Africa- a scoping review

“…The records were mostly published in the last decade (2009-2019). Apart from one study from North Africa [40], all other studies were conducted in sub- Sahara Africa predominantly South Africa [30,[36][37][38]44] and Ethiopia [11,39,42,45,46]. The remaining studies were conducted in Nigeria [35], Ghana [41], and Mozambique [43].…”

“…One study sampled from both streets and shelters [38], and one study failed to mention category of homeless people studied [40]. Only two study assessed the duration of homelessness and found that most participants were chronically homeless [11,39]. Two studies sampled only women [37,45] and the remainder recruited both males and females.…”

“…The nine studies that measured physical health reported a range of illnesses. One study specifically looked at smear positive pulmonary tuberculosis [39], and two studies specifically investigated HIV [44,46]. The other six studies openly explored physical health and identified three groups of health problems: respiratory illnesses, cardiovascular diseases, and disabilities and injuries [30,[35][36][37][38]40].…”

“…Respiratory illnesses were reported in six studies conducted in South Africa [37,38], Ethiopia [39,46], Nigeria [35], and Tunisia [40]. Respiratory and related illnesses reported include pneumonia, asthma and bronchitis [37], pulmonary diseases [40], tuberculosis [37][38][39], and severe coughing [35,37,46]. The estimated prevalence of respiratory illnesses among the participants ranged from 2.6 to 39.2% (see supplementary Table 2).…”

Understanding the Tuberculosis Disease Progression and Future Directions of Research in Tuberculosis: A Mini Review

“…Previously, a MDR-TB contact study has demonstrated children less than 3 years old, HIV positive, exposed to MDR-TB source and poor socioeconomic factor had higher risk for TB infection (Seddon et al 2013). In addition, homeless people who are smoking for more than 5 years and underweight have higher risk of progress to active TB (Semunigus et al 2016).…”