Prevalence and associated factors of tuberculosis among diabetic patients attending public health facilities in Ethiopia: a multicenter study

Individuals with diabetes mellitus (DM) have high tuberculosis (TB) prevalence. Currently, the incidence of DM is increasing in low and middle-income countries including Ethiopia where TB is also endemic, which may complicate TB prevention and control efforts. In this context, the prevalence and associated factors of TB among DM patients are not well understood in Ethiopia. This study assessed the prevalence of TB and associated factors among DM patients attending public health facilities in Ethiopia.

A multicenter cross-sectional study was employed from January to December 2023 among DM patients attending selected public health facilities in five regions of Ethiopia. The consecutive DM patients ≥ 15 years of age were screened for TB and those with signs and symptoms suggestive of TB were enrolled. Patient-related socio-demographic, behavioral, and clinical data were collected. Morning sputum and urine specimens were collected from each participant. Smear microscopy, culture, and Xpert MTB/RIF Ultra assay were conducted. Data were analyzed using SPSS version 27. Descriptive summary measures were computed to characterize the study variables. A logistic regression model was conducted to assess the statistical association between variables.

In total,14,119 DM patients were screened for TB. Of them, 652 (4.62%) were found to have presumptive TB and were enrolled in the study. The mean age of enrolled participants was 55.47 years and 88.3% (576) had type II DM. Among them, 73 (11.2%, 95%CI = 8.7–13.5%) had TB which yielded a point prevalence of 517/100,000 among all screened DM patients. Bacteriological confirmation of TB occurred in 56 cases (8.6%, 95%CI = 6.4–10.6%). The independently associated factors were being younger age group (15–24 years; aOR; 10.98, 95%CI = 1.90-63.56, 25–34 years; aOR; 4.74, 95%CI = 1.12–20.13, 35–44 years; aOR; 5.70, 95%CI = 2.09–15.55, and 45–54 years; aOR; 2.68, 95%CI = 1.22–5.92), cough lasting ≥ two weeks (aOR; 2.73, 95%CI = 1.25–5.60), cigarette smoking (aOR; 7.50, 95%CI = 2.54–22.19), contact with a known TB case (aOR; 9.16, 95%CI = 2.83–29.70), HIV seropositivity (aOR; 4.40, 95%CI = 1.36–14.46), more than 10 years of DM follow-up (aOR; 4.87, 95%CI = 2.06–11.52), insulin medication (aOR; 3.00, 95%CI = 1.16–7.81), and FBS level > 126 mg/dl (aOR; 2.72, 95%CI = 1.26–5.89).

Diabetic patients attending public health facilities in Ethiopia had high TB prevalence. The prevalence of TB was higher among certain DM groups which implies the need for regular TB screening among those groups. The authors recommend the integration of TB screening practice into routine diabetic care.