Tuberculosis in Nigeria

A study in a national TB reference hospital in Nigeria examined how age and gender influence susceptibility to tuberculosis (TB) and drug-resistant TB (DR-TB). Individuals aged 40 or younger were four times more likely to develop DR-TB than older individuals, with 80% of DR-TB cases occurring in this age group. Gender disparities were also evident, as males were generally more susceptible to TB. Among DS-TB cases, 68.3% were male and 31.7% were female, while in DR-TB cases, the male proportion dropped to 55%, suggesting that drug-resistant infections are more evenly distributed between genders.[1]

Beyond age and gender, other factors such as geography, occupation, and environment played a role in TB susceptibility. Urban residency was common in both DS-TB (71.67%) and DR-TB (60%) cases, while a family history of TB was more prevalent in DR-TB patients. Occupational exposure varied, with artisans and business professionals most affected by DS-TB, whereas DR-TB cases included drivers, housewives, and community volunteers. The study also highlighted gaps in BCG vaccination, with only 10% of DR-TB patients having BCG scars compared to 65% of asymptomatic household contacts. Additionally, environmental and dietary factors like raw meat handling and unpasteurized milk consumption may contribute to TB resistance, underscoring the importance of vaccination and lifestyle interventions.[1]

A cross-sectional study conducted from September to December 2018 examined 352 adult volunteers from rural, semi-urban, and urban areas. Participants underwent risk screening using a modified WHO STEPS instrument. The demographic distribution was balanced between males and females, with most individuals being over 40 years old and married or cohabiting. Many participants had no family history of diabetes or tuberculosis, and hypertension was uncommon. However, obesity was more prevalent among urban dwellers. Nearly all participants had received BCG vaccination, and there were no significant differences in CD4+ T lymphocyte counts, hemoglobin levels, or C-reactive protein profiles among the groups. However, total cholesterol levels varied significantly, with rural participants exhibiting slightly higher HDL-C levels.[2]

The study assessed pre-diabetes (PDM) and latent tuberculosis infection (LTBI), finding higher PDM rates in urban areas and higher LTBI rates in rural areas. A small subset of participants had both conditions (PDM-LTBI), with prevalence notably higher among those with LTBI. Bivariate analysis identified age, smoking, family history of diabetes, abdominal obesity, hypertension, and lack of BCG vaccination as risk factors for PDM, while LTBI was also linked to educational level and family history of TB. Logistic regression confirmed that older age, smoking, family history of diabetes, and absence of BCG vaccination significantly predicted both conditions. Adults aged 50-59 years were at the highest risk for concurrent PDM and LTBI, while BCG vaccination was found to significantly reduce this risk.[2]

References:

1. Madaki, S., Mohammed, Y., Rogo, L.D., Yusuf, M. and Bala, Y.G., 2024. Age and gender in drug resistance tuberculosis: a cross-sectional case study at a national tuberculosis reference hospital in Nigeria. Journal of Global Antimicrobial Resistance, 39, pp.175-183.

2. Akinshipe, B.O., Yusuf, E.O., Akinshipe, F.O., Moronkeji, M.A. and Nwaobi, A.C., 2019. Prevalence and Determinants of Pre-diabetes and Latent Tuberculosis Infection Among Apparently Healthy Adults in Three Communities in Southern Nigeria. International Journal of Immunology, 7(2), pp.23-32.