Determinants of Tuberculosis Infection in Diabetic Patients: A Cross-Sectional Analysis of Socio-Demographic, And Risk Factors at Kapsabet County Referral Hospital, Nandi County Kenya

Daniel Korir; Victor Dinda; Jackline Cherotich

doi:10.51867/ajernet.6.2.21

Authors

Daniel Korir Masinde Muliro University of Science and Technology, Kenya
Dinda Victor Masinde Muliro University of Science and Technology, Kenya https://orcid.org/0009-0002-5667-0057
Jackline Cherotich Kobujoi Health Centre, Nandi County, Kenya https://orcid.org/0009-0008-5369-9018

DOI:

https://doi.org/10.51867/ajernet.6.2.21

Keywords:

Co-infection, Cross-Sectional Study, Diabetes Mellitus (DM), Environmental Risk Factors, Glycaemic Control, Kapsabet County Referral Hospital, Socio-Demographic Factors, Tuberculosis (TB)

Abstract

The co-infection of Tuberculosis (TB) and Diabetes Mellitus (DM) presents a critical public health challenge, especially within low-resource settings where healthcare systems struggle with limited resources. Diabetic patients are at heightened risk of developing TB, yet factors influencing TB infection within this population are not thoroughly understood. This study investigates the prevalence and determinants of TB infection among diabetic patients at Kapsabet County Referral Hospital. The research addresses gaps in knowledge regarding how socio-demographic, individual, and environmental factors interact to influence TB susceptibility among this vulnerable group. Employing a descriptive cross-sectional design, data were collected from 60 diabetic patients selected through a simple random sampling technique. Data were obtained via structured questionnaires, patient interviews, and medical record reviews. Statistical analysis included descriptive statistics, Chi-square tests, and ANOVA to explore associations between TB infection status and various predictors. The sample’s socio-demographic characteristics and diabetes-related variables were analysed using SPSS, with significant relationships identified at a p-value of <0.05. Results revealed a TB prevalence rate of 16.7% for active cases and 8.3% for latent infections among diabetic patients. The Chi-square analysis indicated that lower education levels (p = 0.031) and lower income brackets (p = 0.024) were significantly associated with TB infection status. Additionally, individual factors, including Type 2 diabetes (p = 0.014) and poor glycaemic control (p = 0.022), were identified as significant predictors of TB risk. ANOVA results further demonstrated that patients residing in overcrowded environments exhibited higher mean TB infection rates compared to those in less crowded conditions, F (2,57) = 5.26, p = 0.009. Frequent exposure to known TB cases was also significantly associated with infection status (p = 0.015). In conclusion, this study highlights a substantial burden of TB-DM co-infection within the study population, with socio-demographic, individual, and environmental factors significantly influencing TB risk. The findings underscore the need for integrated TB and diabetes management strategies that consider socio-economic and environmental conditions. Targeted interventions focusing on improving diabetes care, enhancing patient education, and reducing exposure to environmental risk factors are recommended to mitigate TB risk among diabetic patients.

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References

Acharya, A. S., Prakash, A., Saxena, P., & Nigam, A. (2013). Sampling: Why and how of it. Indian Journal of Medical Specialities, 4(2), 330-333. https://doi.org/10.7713/ijms.2013.0032 DOI: https://doi.org/10.7713/ijms.2013.0032

Alemu, A., Bitew, Z. W., Diriba, G., & Gumi, B. (2021). Co-occurrence of tuberculosis and diabetes mellitus, and associated risk factors, in Ethiopia: A systematic review and meta-analysis. IJID Regional, 1, 82-91. https://doi.org/10.1016/j.ijregi.2021.10.004 DOI: https://doi.org/10.1016/j.ijregi.2021.10.004

Alemu, A., Seid, G., Diriba, G., Belay, H., Tsegaye, A., & Tola, H. (2025). Prevalence and associated factors of tuberculosis among diabetic patients attending public health facilities in Ethiopia: A multicenter study. Archives of Public Health, 83, 40. https://doi.org/10.1186/s13690-025-01530-6 DOI: https://doi.org/10.1186/s13690-025-01530-6

Amayo, G. N., & Mutai, J. (2020). Diabetes prevalence among tuberculosis patients in Kenya: Findings from Kenyatta National Hospital and Mbagathi Level 5 Hospital. African Journal of Public Health, 29(4), 319-326.

Bailey, S. L., & Grant, P. (2011). The tubercular diabetic: The impact of diabetes mellitus on tuberculosis and its threat to global tuberculosis control. Clinical Medicine (London), 11(4), 344-347. https://doi.org/10.7861/clinmedicine.11-4-344

https://doi.org/10.7861/clinmedicine.11-4-344 DOI: https://doi.org/10.7861/clinmedicine.11-4-344

Boadu, A. A., Yeboah-Manu, M., Osei-Wusu, S., & Yeboah-Manu, D. (2024). Tuberculosis and diabetes mellitus: The complexity of the comorbid interactions. International Journal of Infectious Diseases, 146, 45-52.

https://doi.org/10.1016/j.ijid.2024.107140 DOI: https://doi.org/10.1016/j.ijid.2024.107140

Chandra, P., Grigsby, S. J., & Philips, J. A. (2022). Immune evasion and provocation by Mycobacterium tuberculosis. Nature reviews. Microbiology, 20(12), 750-766. https://doi.org/10.1038/s41579-022-00763-4 DOI: https://doi.org/10.1038/s41579-022-00763-4

Chauhan, A., Parmar, M., Dash, G. C., Chauhan, S., Sahoo, K. C., Samantaray, K., Sharma, J., Mahapatra, P., & Pati, S. (2024). Health literacy and tuberculosis control: Systematic review and meta-analysis. Bulletin of the World Health Organization, 102(6), 421-431. https://doi.org/10.2471/BLT.23.290396 DOI: https://doi.org/10.2471/BLT.23.290396

Dooley, K. E., & Chaisson, R. E. (2009). Tuberculosis and diabetes mellitus: Convergence of two epidemics. The Lancet Infectious Diseases, 9(12), 737-746. https://doi.org/10.1016/S1473-3099(09)70282-8 DOI: https://doi.org/10.1016/S1473-3099(09)70282-8

Gupta, A., Chandra, E., & Mrigpuri, P. (2025). Navigating the dual burden of diabetes mellitus and tuberculosis: A comprehensive review of clinical and public health strategies. Indian Journal of Tuberculosis, 72(1), 1-10.

https://doi.org/10.1016/j.ijtb.2025.03.011 DOI: https://doi.org/10.1016/j.ijtb.2025.03.011

Imam, F., Sharma, M., Obaid Al-Harbi, N., Rashid Khan, M., Qamar, W., Iqbal, M., Daud Ali, M., Ali, N., & Khalid Anwar, M. (2021). The possible impact of socioeconomic, income, and educational status on adverse effects of drug and their therapeutic episodes in patients targeted with a combination of tuberculosis interventions. Saudi Journal of Biological Sciences, 28(4), 2041-2048. https://doi.org/10.1016/j.sjbs.2021.02.004 DOI: https://doi.org/10.1016/j.sjbs.2021.02.004

Kompala, T., Shenoi, S. V., & Friedland, G. (2013). Transmission of tuberculosis in resource-limited settings. Current HIV/AIDS Reports, 10(3), 264-272. https://doi.org/10.1007/s11904-013-0164-x DOI: https://doi.org/10.1007/s11904-013-0164-x

Krishna, S., & Jacob, J. J. (2021). Diabetes mellitus and tuberculosis. In K. R. Feingold, S. F. Ahmed, B. Anawalt, et al. (Eds.), Endotext. MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK570126/

Krishnappa, D., Sharma, S. K., Singh, A. D., Sinha, S., Ammini, A. C., & Soneja, M. (2019). Impact of tuberculosis on glycaemic status: A neglected association. Indian Journal of Medical Research, 149(3), 384-388.

https://doi.org/10.4103/ijmr.IJMR_1927_17 DOI: https://doi.org/10.4103/ijmr.IJMR_1927_17

Litvinjenko, S., Magwood, O., Wu, S., & Wei, X. (2023). Burden of tuberculosis among vulnerable populations worldwide: An overview of systematic reviews. The Lancet Infectious Diseases, 23(12), 1395-1407. https://doi.org/10.1016/S1473-3099(23)00372-9

Litvinjenko, S., Magwood, O., Wu, S., & Wei, X. (2023). Erratum to: Burden of tuberculosis among vulnerable populations worldwide: An overview of systematic reviews. Lancet Infectious Diseases, 23(11), e467. https://doi.org/10.1016/S1473-3099(23)00625-4 DOI: https://doi.org/10.1016/S1473-3099(23)00372-9

Mabula, P. L., Kazinyingia, K. I., Chavala, E. C., Mosha, V., Msuya, S. E., & Leyaro, B. J. (2021). Prevalence and risk factors for diabetes mellitus among tuberculosis patients in Moshi Municipal Council, Kilimanjaro, Tanzania. East African Health Research Journal, 5(1), 69-74. https://doi.org/10.24248/eahrj.v5i1.658 DOI: https://doi.org/10.24248/eahrj.v5i1.658

Maganty, A., Byrnes, M. E., Hamm, M., Wasilko, R., Sabik, L. M., Davies, B. J., & Jacobs, B. L. (2023). Barriers to rural health care from the provider perspective. Rural and Remote Health, 23(2), 7769. https://doi.org/10.22605/RRH7769 DOI: https://doi.org/10.22605/RRH7769

Mburu, J. W., Kingwara, L., Ester, M., & Andrew, N. (2018). Prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 12, 9-13. https://doi.org/10.1016/j.jctube.2018.04.005 DOI: https://doi.org/10.1016/j.jctube.2018.04.005

Meng, F., Lan, L., Wu, G., Ren, X., Yuan, X., Yang, M., Chen, Q., Peng, X., & Liu, D. (2023). Impact of diabetes itself and glycemic control status on tuberculosis. Frontiers in Endocrinology, 14, Article 1197095.

https://doi.org/10.3389/fendo.2023.1250001 DOI: https://doi.org/10.3389/fendo.2023.1250001

Muniyandi, M., Rajeswari, R., Balasubramanian, R., & Narayanan, P. R. (2007). Socioeconomic dimensions of tuberculosis control: Review of studies from India. Tuberculosis Research and Control, 4(2), 105-114.

Ong, K. L., Cho, N. H., Deng, Y., Narayan, K. M. V., & Chan, J. C. N. (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet, 402(10397), 203-234. https://doi.org/10.1016/S0140-6736(23)01301-6 DOI: https://doi.org/10.1016/S0140-6736(23)01301-6

Park, J. E., Kibe, P., Yeboah, G., Oyebode, O., Harris, B., Ajisola, M. M., Griffiths, F., Aujla, N., Gill, P., Lilford, R. J., & Chen, Y. F.; Improving Health in Slums Collaborative. (2022). Factors associated with accessing and utilisation of healthcare and provision of health services for residents of slums in low and middle-income countries: A scoping review of recent literature. BMJ Open, 12(5), e055415. https://doi.org/10.1136/bmjopen-2021-055415 DOI: https://doi.org/10.1136/bmjopen-2021-055415

Revelle, W., & Condon, D. M. (2019). Reliability from α to ω: A tutorial. Psychological Assessment, 31(12), 1395-1411. https://doi.org/10.1037/pas0000754 DOI: https://doi.org/10.1037/pas0000754

Ringwald, B., Mwiine, A. A., Chikovore, J., Makanda, G., Amoah-Larbi, J., Millington, K. A., & Horton, K. C. (2023). Ending TB means responding to socially produced vulnerabilities of all genders. BMJ Global Health, 8(12), e014151. https://doi.org/10.1136/bmjgh-2023-014151 DOI: https://doi.org/10.1136/bmjgh-2023-014151

Sharma, S., & Mohan, A. (2023). Tuberculosis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441916/

Workneh, M. H., Bjune, G. A., & Yimer, S. A. (2017). Prevalence and associated factors of tuberculosis and diabetes mellitus among patients in a tuberculosis referral hospital in Ethiopia. BMC Infectious Diseases, 17(1), 35.

World Health Organization (WHO) Regional Office for Africa. (2025). Tuberculosis (TB). Retrieved April 26, 2025, from https://www.afro.who.int/health-topics/tuberculosis-tb

World Health Organization (WHO). (2020). Global Tuberculosis Report 2020. Geneva: World Health Organization. Retrieved from https://www.who.int/tb/publications/global_report/en/

World Health Organization (WHO). (2023). Tuberculosis. Retrieved April 26, 2025, from https://www.who.int/news-room/fact-sheets/detail/tuberculosis

World Health Organization (WHO). (2024). Tuberculosis. Retrieved April 26, 2025, from https://www.who.int/news-room/fact-sheets/detail/tuberculosis#:~:text=A%20total%20of%201.25%20million,lives%20since%20the%20year%202000

World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191-2194. https://doi.org/10.1001/jama.2013.281053 DOI: https://doi.org/10.1001/jama.2013.281053

Yamane, T. (1967). Statistics: An introductory analysis (2nd ed.). Harper and Row.

Zhao, L., Gao, F., Zheng, C., & Sun, X. (2024). The impact of optimal glycemic control on tuberculosis treatment outcomes in patients with diabetes mellitus: Systematic review and meta-analysis. JMIR Public Health and Surveillance, 10, e53948. https://doi.org/10.2196/53948 DOI: https://doi.org/10.2196/53948