EC Pulmonology and Respiratory Medicine

Research Article Volume 12 Issue 5 - 2023

Co-Morbidity of Chronic and Communicable Diseases in Nigeria: A Study on the Relationship between Diabetes and Tuberculosis

CE Ijioma1*, OR Omole2, OJ Orji3, OE Aminu-Ayinde4, EA Kalesanwo5, IE Okeji6, NC Ekeleme7, IO Abali8, VU Uduma9 and AI Airaodion10

1Department of Internal Medicine, Abia State Specialist Hospital and Diagnostic Centre, Umuahia, Nigeria

2Department of Community Health Nursing, West African College of Nursing and Midwifery, Lagos State, Nigeria

3Department of Acute Medicine, University Hospitals of Derby and Burton, NHS Foundation Trust, UK

4Accident and Emergency Unit, Mountain Top University Hospital, Prayer City, Ogun State, Nigeria

5Department of Surgery, Olabisi Onabanjo University Hospital, Sagamu, Ogun State, Nigeria

6Department of General Medicine, North Cumbria Integrated Care, NHS Foundation Trust, UK

7Department of Community Medicine, Abia State University Teaching Hospital, Aba, Nigeria

8Department of Surgery, Abia State University, Uturu, Nigeria

9Department of Internal Medicine, Pulmonology Division, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria

10Department of Biochemistry, Federal University of Technology, Owerri, Imo State, Nigeria

*Corresponding Author: CE Ijioma, Department of Internal Medicine, Abia State Specialist Hospital and Diagnostic Centre, Umuahia, Nigeria.
Received: June 07, 2023; Published:June 29, 2023

Aim: This study provides comprehensive insights into the co-morbidity of diabetes and tuberculosis in Nigeria.

Methodology: This study was cross-sectional in design. The population under study consisted of individuals in Nigeria diagnosed with diabetes and/or tuberculosis. A purposive sampling technique was employed for data collection. The inclusion criteria for the study were individuals who were diagnosed with diabetes and/or tuberculosis and were receiving treatment for the condition(s). A structured questionnaire was administered to three hundred and eighty (380) patients diagnosed with diabetes and/or tuberculosis and attending the outpatient clinic of the University College Hospital (UCH), Ibadan, Nigeria. Data collected were coded and entered into SPSS (version 26.0) for analysis. Descriptive statistics (frequencies, percentages) were calculated for each variable in the study. Cross-tabulation was performed to examine the relationships between variables and Chi-square tests were used to test for statistical significance. The p-value was set at 0.05 for statistical significance.

Results: The results showed that 70.73% of the respondents were diagnosed with diabetes and 36.86% with tuberculosis. Among the participants with both diseases, 39.29% were diagnosed with tuberculosis before diabetes, 46.43% after, and 14.29% at the same time. An important finding of this study revealed that 64.29% of participants with both conditions noticed interactions or effects between their diabetes and tuberculosis conditions. Factors such as age, sex, occupation, smoking habits, and alcohol consumption significantly influenced the co-morbidity of these diseases. The study noted a lack of awareness about the link between diabetes and tuberculosis among 47.15% of the participants, whereas 76.15% felt more should be done to raise awareness in Nigeria. Healthcare access and quality survey showed that 75% of those with both diseases faced challenges in managing the conditions, yet 89.29% were receiving specialized medical care. Statistical analysis identified significant correlations between the co-morbidity of diabetes and tuberculosis with age (p = 0.033), sex (p = 0.019), occupation (p = 0.037), smoking (p = 0.008), and alcohol consumption (p = 0.044).

Conclusion: This study underscores the need for improved health education and preventative measures for diabetes and tuberculosis co-morbidity in Nigeria. Further studies are recommended to strengthen these findings and develop effective health intervention strategies.

Keywords: Co-Morbidity; Diabetes; Risk Factors; Tuberculosis

  1. Jeon CY and Murray MB. “Diabetes mellitus increases the risk of active tuberculosis: A systematic review of 13 observational studies”. PLoS Medicine7 (2018): e152.
  2. Baker MA., et al. “The impact of diabetes on tuberculosis treatment outcomes: A systematic review”. BMC Medicine1 (2021): 81.
  3. World Health Organization and International Union Against Tuberculosis and Lung Disease. Collaborative framework for care and control of tuberculosis and (2021).
  4. Airaodion AI., et al. “Antidiabetic effect of ethanolic extract of Carica papaya leaves in alloxan-induced diabetic rats”. International Journal of Bio-Science and Bio-Technology8 (2019): 93-109.
  5. American Diabetes Association. Eating Well. Diabetes Food Hub (2021).
  6. World Health Organization. Global Tuberculosis Report. Geneva, Switzerland (2020).
  7. World Health Organization. Global status report on noncommunicable diseases. WHO (2014).
  8. Dooley KE and Chaisson RE. “Tuberculosis and diabetes mellitus: convergence of two epidemics”. The Lancet Infectious Diseases12 (2009): 737-746.
  9. International Diabetes Federation. IDF Diabetes Atlas, 9th edition. Brussels, Belgium (2019).
  10. Harries AD., et al. “The looming epidemic of diabetes-associated tuberculosis: learning lessons from HIV-associated tuberculosis”. The International Journal of Tuberculosis and Lung Disease11 (2011): 1436-1444.
  11. Lonnroth K., et al. “Drivers of tuberculosis epidemics: the role of risk factors and social determinants”. Social Science and Medicine12 (2009): 2240-2246.
  12. Restrepo BI. “Diabetes and Tuberculosis”. Microbiology Spectrum6 (2016).
  13. Stevenson CR., et al. “Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence”. BMC Public Health 7 (2007): 234.
  14. Baker MA., et al. “The risk of tuberculosis disease among persons with diabetes mellitus: a prospective cohort study”. Clinical Infectious Diseases6 (2012): 818-825.
  15. Cohen S., et al. “Psychological stress and disease”. The Journal of the American Medical Association14 (2015): 1685-1687.
  16. Lönnroth K., et al. “A consistent log-linear relationship between tuberculosis incidence and body mass index”. International Journal of Epidemiology1 (2010): 149-155.
  17. Smith SG., et al. “Social isolation, health literacy, and mortality risk: findings from the English Longitudinal Study of Ageing”. Health Psychology2 (2017): 160.
  18. Lönnroth K., et al. “Drivers of tuberculosis epidemics: the role of risk factors and social determinants”. Social Science and Medicine12 (2008): 2240-2246.
  19. Colberg SR., et al. “Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association”. Diabetes Care11 (2016): 2065-2079.
  20. Gupta RB., et al. “What is the burden of extrapulmonary tuberculosis? A review of global and national estimates”. Expert Review of Respiratory Medicine10 (2019): 951-965.
  21. Mitchison DA. “The diagnosis and therapy of tuberculosis during the past 100 years”. American Journal of Respiratory and Critical Care Medicine7 (2005): 699-706.
  22. Centers for Disease Control and Prevention. TB Treatment (2020).
  23. Hu FB. “Globalization of Diabetes”. Diabetes Care6 (2011): 1249-1257.
  24. Ley SH., et al. “Prevention and management of type 2 diabetes: dietary components and nutritional strategies”. The Lancet9933 (2014): 1999-2007.
  25. Malik VS., et al. “Global obesity: trends, risk factors and policy implications”. Nature Reviews Endocrinology1 (2013): 13-27.
  26. Lin HH., et al. “Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis”. PLOS Medicine1 (2007): e20.
  27. Edwards KM and Walker A. “Exercise and immune function: effects of chronic exercise”. Immunology and Cell Biology5 (2008): 397-405.
  28. Spiegel K., et al. “Effects of poor and short sleep on glucose metabolism and obesity risk”. Nature Reviews Endocrinology5 (2009): 253-261.
  29. Cappuccio FP., et al. “Sleep Duration and All-Cause Mortality: A Systematic Review and Meta-Analysis of Prospective Studies”. Sleep5 (2010): 585-592.
  30. Besedovsky L., et al. “Sleep and immune function”. Pflugers Archiv European Journal of Physiology1 (2012): 121-137.
  31. Restrepo BI., et al. “Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases”. Bulletin of the World Health Organization5 (2011): 352-359.
  32. Noubiap JJ., et al. “Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2·3 million patients with tuberculosis”. The Lancet Global Health4 (2015): e448-e460.
  33. Workneh MH., et al. “Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: A systematic review”. PloS One4 (2016): e0153963.
  34. Fortin M., et al. “Prevalence of multimorbidity among adults seen in family practice”. Annals of Family Medicine3 (2005): 223-228.
  35. France EF., et al. “Multimorbidity in primary care: a systematic review of prospective cohort studies”. British Journal of General Practice597 (2012): e297-e307.
  36. Schäfer I., et al. “The influence of age, gender and socio- economic status on multimorbidity patterns in primary care. First results from the multicare cohort study”. BMC Health Services Research 12 (2012): 89.
  37. Bodenheimer T., et al. “Patient self-management of chronic disease in primary care”. The Journal of the American Medical Association19 (2002): 2469-2475.
  38. O'Brien R., et al. “An 'endless struggle': a qualitative study of general practitioners' and practice nurses' experiences of managing multimorbidity in socio-economically deprived areas of Scotland”. Chronic Illness1 (2011): 45-59.
  39. Naidoo P., et al. “The South African Tuberculosis Care Cascade: Estimated Losses and Methodological Challenges”. The Journal of Infectious Diseases7 (2017): S702-S713.
  40. Mercer SW., et al. “Multimorbidity in primary care: developing the research agenda”. Family Practice2 (2009): 79-80.
  41. World Health Organization. Tuberculosis (2021).
  42. Marais BJ., et al. “Tuberculosis comorbidity with communicable and noncommunicable diseases: integrating health services and control efforts”. The Lancet Infectious Diseases5 (2013): 436-448.
  43. Ko PY and Lin SD. “The relationship between tuberculosis and diabetes in Taiwan: A national health insurance-based study”. Public Health 134 (2016): 70-77.
  44. Bates MN., et al. “Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis”. Archives of Internal Medicine4 (2007): 335-342.
  45. Wipfli H and Samet J. “One hundred years in the making: the global tobacco epidemic”. Annual Review of Public Health 37 (2016): 149-166.
  46. Baliunas D., et al. “Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta- analysis”. International Journal of Public Health3 (2010): 159-166.
  47. Thomas DE., et al. “Exercise for type 2 diabetes mellitus”. Cochrane Database of Systematic Reviews 3 (2006): CD002968.

CE Ijioma., et al. "Co-Morbidity of Chronic and Communicable Diseases in Nigeria: A Study on the Relationship between Diabetes and Tuberculosis". EC Pulmonology and Respiratory Medicine  12.5 (2023): 01-17.