Risk Factors Associated with Pulmonary Tuberculosis among HIV/AIDs Patients Visiting Mbagathi County Hospital, Nairobi, Kenya

Research Article

Austin J HIV/AIDS Res. 2022; 8(1): 1051.

Risk Factors Associated with Pulmonary Tuberculosis among HIV/AIDs Patients Visiting Mbagathi County Hospital, Nairobi, Kenya

Oyunge RN and Ndukui JG*

School of Nursing, Catholic University of Eastern Africa, Lang’ata Campus, Kenya

*Corresponding author: James Gakunga Ndukui, School of Nursing, Catholic University of Eastern Africa, Lang’ata Campus, P.O.Box 62157-00200 Nairobi - Kenya

Received: April 12, 2022; Accepted: September 12, 2022; Published: September 19, 2022


Background: Pulmonary Tuberculosis (PTB) remains a serious global public health concern ranked second to HIV as the leading cause of mortality from infectious diseases especially in developing countries. In 2012, PTB was associated with a global morbidity of 8.6 million and a mortality of 1.3 million annually with 320,000 of these deaths associated with HIV-TB co-infection. Developing countries like Kenya accounts for over 80% of global PTB burden and also has the highest HIV prevalence (WHO, 2013; 2009). The objective of this study was to determine the risk factors associated with pulmonary tuberculosis among HIV/AIDs patients visiting Mbagathi County Hospital.

Methods and Materials: A hospital-based, cross-sectional study design was conducted among 159 patients visiting Mbagathi County Hospital. Systematic random sampling method was used to select the study participants from the TB/HIV wards and from the CCC clinic until a sample size of 159 was achieved. A pre-tested, semi-structured questionnaire was used to collect data from the participants. Data was analyzed using SPSS software version 22.0.

Results: A total of 159 (n) participants were selected to participate in the study in Mbagathi County Hospital. All the participants selected for the study were HIV patients above 18 years of age. Most of them were male (62.9%). Most of them were married (58.5%). Most of them did not have a family history of TB (86.2%). Most of the respondents completed their education in high school (52.8%). Most of them were unemployed (76.1%) and most of them had an income of less than 10,000 shillings a month (83.0%). In this study I found out that most respondents had poor dietary habits, most of the respondents were smokers (68.6%) and were not aware of the effects of smoking on their health and most of the respondents had poor adherence to drugs. Factors such as occupation, family income, balanced meal and stopping to take medication whenever they felt their condition was under control had a significant association with the occurrence of PTB. While factors like age, gender, number of meals taken in a day, wanting to quit smoking and forgetting to take medication had no significant association with the occurrence of PTB in this study.

Conclusion: The study provides key insights into the risk factors associated with pulmonary tuberculosis among HIV/AIDs patients visiting Mbagathi County Hospital. The findings of this study therefore suggest that there was a significant association between level of education, monthly income, occupation, family history of PTB, lacking food appetite, taking a balanced meal, observing a healthy nutrition, smoking and stopping to take medication when one feels condition is under control with the occurrence of PTB among HIV/AIDs patients visiting Mbagathi County Hospital. Factors such as age, gender, marital status, number of meals eaten in a day, willingness to quit smoking and feeling hassled about sticking to treatment had no significant association with the occurrence of PTB.

Keywords: Pulmonary tuberculosis; HIV/AIDS; Mycobacterium tuberculosis; Chronic obstructive pulmonary disease; Comprehensive care clinic; World health organization

Abbreviations and Acronyms

CCC: Comprehensive Care Clinic; CDC: Centers for Disease Control and Prevention; COPD: Chronic Obstructive Pulmonary Disease; CVD: Cardiovascular Disease; HIV: Human Immunodeficiency Virus; MOH: Ministry of Health; PLHIV: People Living with Human Immunodeficiency Virus; PTB: Pulmonary Tuberculosis; TB: Tuberculosis

Background Information

Globally, HIV/AIDs is a continuing health problem that causes high morbidity and mortality, especially in third world countries. Since its discovery, it has caused more than 35 million deaths, and as of 2015, about 37 million people were living with HIV/AIDS [28]. Tuberculosis is ranked second from HIV as a serious global health concern that leads to mortality from infectious diseases, mostly in third-world countries. In 2012, pulmonary tuberculosis was associated with worldwide morbidity of 8.6 million and a mortality of 1.3 million annually, with 320,000 of these deaths related to HIV-TB co-infection [21]. Kenya, a developing country, is ranked fifteenth. It accounts for over 80% of the global tuberculosis burden and has the highest HIV prevalence (WHO, 2013; 2009). In HIV-infected persons globally, pulmonary tuberculosis is the leading cause of respiratory morbidity and mortality, as suggested by data, accounting for 44% of all AIDS-related deaths (WHO, 2012). A recent study shows that P.T.B. incidences still account for over 39% of all T.B. cases in HIV-positive adults (Yuen; et al., 2014). However, the incidence is declining among HIV-negative adults in Kenya, suggesting that HIV impacts both the epidemiology and clinical outcomes of pulmonary tuberculosis.

There were 10.4 million new tuberculosis cases worldwide, with 11% of these cases being HIV co-infected, according to a 2016 WHO report. Additionally, the deaths worldwide were 1.8 million, with 0.4 million occurring among HIV-positive patients. The first manifestation of HIV/AIDS is pulmonary tuberculosis in more than 50% of HIV-positive patients. The deaths linked to P.T.B. are significantly high, especially in Sub-Saharan Africa, where this rate in some countries is reported to be more than 50%.

In terms of the impact of TB-HIV co-infection, Sub-Saharan Africa is reported as the most affected region (WHO, 2009). The relatively high rates of HIV co-infection cause the high incidence rates thus, a tremendous public health challenge is posed by P.T.B. and HIV coinfection in this region (WHO, 2013, 2009). Kenya, which is ranked 5th in terms of tuberculosis burden in Africa, indicates that 39% were TB-HIV co-infected in 103,159 TB cases (Ministry of Health, 2013). Additional data suggest that the mortality rate attributed to P.T.B. in patients co-infected with HIV is above 130 per 100,000 (Ministry of Public Health and Sanitation, 2009). Due to factors that influence tuberculosis trends, in the past decade, the incidence of pulmonary tuberculosis infection has remarkably increased by 10%. However, the main reason for the increase is primarily due to the HIV epidemic and poverty (Borus; et al., 2013).

Public health interventions by the National T.B. and leprosy Program, WHO Stop T.B. strategy, and TB-HIV collaborative activities adopted and implemented at different levels nationwide have led to the evolution of the epidemiology of Tuberculosis in Kenya over time (Borus; et al., 2013). The risk factors associated with pulmonary tuberculosis among people living with HIV/AIDS could generally be divided into biological and non-biological factors. Biological factors are more evident. When individuals infected with HIV are infected with Mycobacterium tuberculosis, it can stimulate replication of the virus and accelerate the progression of the HIV disease. HIV infection induces cytokines-II, making a person get active pulmonary tuberculosis easier. External factors are, however, very complicated. Disease transmission can be influenced by social activities and the environment, which change their expected course.

It is essential to have a screening strategy to detect HIV among PTB patients and a screening program to see P.T.B. among HIVpositive patients to ensure effective collaboration between HIV/AIDs and tuberculosis control programs. The process is easy and can be done through a blood test quickly. HIV-infected PTB patients often lack the classic clinical symptoms of P.T.B.; thus, the latter is still challenging in many countries. Therefore, many studies have been done to determine the risk factors associated with P.T.B. among HIVinfected persons. These factors include different socio-demographic characteristics, WHO-clinical stage, CD4 count, antiretroviral and anti-TB therapeutic drug combinations, poor dietary habits, smoking and presenting symptoms.

The identified knowledge gaps include Community-level interventions, including care of the family, and the best way to deliver these interventions to effectively reduce the prevalence of T.B. in communities highly affected by HIV, Community-level impact of the implementation of collaborative TB/HIV interventions on tuberculosis and HIV transmission, the cost-effectiveness of collaborative TB/HIV interventions delivered through a community approach, efficacy, feasibility and acceptability of mass or targeted interventions for T.B. and HIV prevention and care in HIV-prevalent settings and the best delivery models of collaborative TB/HIV interventions to most-at-risk populations and special populations in all environments with different T.B. and HIV epidemiology and epidemic states(WHO, 2010).

This research is essential, and it fits into the existing gaps of the study whereby there will be an outcome to clarify the factors associated with pulmonary T.B. among HIV patients visiting Mbagathi County Hospital after completion of the study. It will add new findings to the existing body of literature.

Materials and Methods

Study Design

The study was a hospital-based-descriptive cross-sectional study design. A pre-tested questionnaire was used to investigate the risk factors associated with P.T.B. among HIV patients.

Study Area

The study was carried out at Mbagathi County Hospital located in Nairobi County. It is a public health facility under the County Government of Nairobi’s Department of Health Services. It has inpatient and outpatient services for adults and children with a 320- bed capacity including a 100-bed maternity wing. A wide range of services are offered including accident and emergency, inpatient services, laboratory services, dental clinic services, radiology services, antenatal services, comprehensive care clinic services, ear nose and throat clinic services, eye clinic services, gynecology outpatient clinic services, pediatric outpatient clinic services, medical outpatient clinic services and surgical outpatient clinical services.

Study Population

The study population was HIV patients who visited Mbagathi County hospital during the study period.

Inclusion Criteria

All HIV patients that were aged above 18 years and that gave informed consent in the TB/HIV wards and at the CCC Clinic in Mbagathi County Hospital.

Exclusion Criteria

All HIV patients who transferred out to different hospitals, individuals with no HIV, HIV patients below 18 years and HIV patients who did not want to engage in the study.

Sample Size Determination

The sample size was determined using Fischer’s formula (Fischers et al., 1998).

n = z²p (1-p)/d²

n= sample size

Z = Normal deviation at the desired confidence interval. In this case, it was taken at 95%. Z value at 95% is 1.96.

Q (1-P) = Proportion of the population without the desired characteristic.

d² = Degree of precision is taken to be 5%

According to NCBI, the Proportion of TB-HIV infection was taken to be 33.2%.

n = (1.96)² 0.332 0.668/ 0.05²

= 341

The sample size adjustment of the population was done since the target population is less than 10,000.

nf = n/(1 + n/N)

nf = The desired sample size for population less than 10,000

N = Total population during the data collection period

n = the calculated sample size = 341

nf = 341/(1 + 341/300)

Therefore, the minimum sample size of the study was 159 (n=159) patients.

Sampling Method and Recruitment Process

The systematic random sampling method was used to select participants for the study. The HIV center at Mbagathi County hospital attended an average of 20 patients in a day, equivalent to 600 in a month, which was the study period. The six hundred patients in a single month were divided by the adjusted sample size (159) to get a sampling interval of 3. Consequently, every third patient was included in the study till the desired sample size was achieved.

Data Collection Tools and Questionnaires

Data was collected using pretested closed ended questionnaires from HIV patients visited Mbagathi County Hospital during the study period. The following data was collected: Demographic and Socio-economic data of participants, smoking characteristics, dietary habits and drug adherence characteristics. The questionnaire was pre-tested among 8 participants (5% of the sample size) at Thika Level 5 Hospital. Any ambiguity was corrected before the actual data collection took place.

Data Analysis

Data was analyzed using SPSS version 22 and descriptive analysis was done using frequency, proportion and percentages. Crosstabulation was used to get the association between dependent variable and independent variables, while statistical significance between categorical data was calculated using chi-square test. A P-value of less than 0.05 was considered statistically significant.

Ethical Consideration

Ethical clearance for conducting this study was sought from The Catholic University of Eastern Africa Administration at the School of Nursing, KNH-UON Ethics and Research Committee (UP965/12/2021), NACOSTI (License No: NACOSTI/P/22/16474), Nairobi Metropolitan Services and the Department of HIV Mbagathi County Hospital. Both oral and written consent was sought from each participant of the study after explaining in detail the method and procedure involved in the study in a language they were conversant with before interviewing them. The study individuals were advised that their participation was voluntary, have the right to invite any question and to get out of the study any time without giving any reason. Participants were educated about the study’s purpose, the time they spend during the interview, benefits, and risks of their participation. No identifications of study participants (names and addresses) were documented in the questionnaires to enhance confidentiality. Privacy was maintained during the data collection period.


Socio-Demographic Characteristics of the Respondents

The majority of respondents (64.2%) were above the age of 50. Majority of the participants were male (62.9%), with 37.1 percent being female. 58.5 percent of the respondents were married, 21.4 percent were single and 20.1 percent were divorced, separated or widowed. Most of the respondents did not have a family history of TB (n=137, 86.2%) followed by 13.8 percent who had a family history of TB. Majority of the respondents had ever experienced pulmonary tuberculosis in the past six months (59.1%).

Majority of the respondents (52.8%) completed their education in high school, followed by 26.4 percent who completed in college and the remaining 20.8 percent completed their education at the primary level. Out of the 159 respondents, 76.1 percent were unemployed and 23.9 percent were employed. Majority of the participants (83 percent) earned less than 10000 shillings per month, followed by those earning 10000-15000 shillings per month (11.9%), with the remaining 5.1 percent earning more than 15000 shillings per month. The sociodemographic characteristics of the respondents are shown by the table below (Table 1).