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ORIGINAL RESEARCH

Undernutrition and Associated Factors Among

Adult Tuberculosis Patients in Jigjiga Public Health
Facilities, Somali Region, East, Ethiopia
Research and Reports in Tropical Medicine downloaded from https://www.dovepress.com/ on 26-Oct-2022

Abdilahi Ibrahim Muse 1 Background: Tuberculosis and undernutrition are the public health concerns of people living in
2 middle and low-income countries. When patient develops TB, undernutrition is not only a risk
Mohamed Omar Osman
2 factor for progression of latent TB infection to active disease, but also intensifies the risk of drug
Ahmed Mohammed Ibrahim
Girma Tadesse Wedajo 2 toxicity, relapse and death. Nutritional supplementation in patients with TB is associated with
For personal use only.

faster sputum conversion, higher cure and treatment completion rates, and body-weight gain.
Fuad Ismail Daud1
Objective: To find out the magnitude of undernutrition and associated factors among adult
Kalkidan Hassen Abate3
tuberculosis patients in jigjiga public health facilities.
1
Department of Nursing, College of Methods and Materials: A facility-based cross-sectional study design was applied. Data were
Medicine and Health Science, Jigjiga
University, Jigjiga, Ethiopia; 2Department collected using a structured questionnaire while anthropometric measurements were collected in
of Public Health, College of Medicine and their scale measurements. The data were entered into an Epi-data version 3.1, then were exported
Health Science, Jigjiga University, Jigjiga, and analyzed using SPSS v20. Bivariate logistic regression was done to assess the association
Ethiopia; 3Department of Population and
Family Health, Jimma University, Jimma, between the outcome variable and the independent variables, value <0.25 was considered as
Ethiopia a candidate for multivariate logistic regression at 95% CI. In multivariable logistic regression
analysis, the level of statistical significance was declared at a p-value less than 0.05.
Results: The magnitude of undernutrition was 44.3% [95% CI (38.2, 49.7)]. Sex (female)
[AOR=1.769, CI=1.035, 3.024], educational status [AOR=3.939, CI=2.285, 6.792] and being
Bedridden [AOR=3.718, CI=1.115, 12.394) were predictors of Undernutrition among adult tuber­
culosis patients.
Conclusion: The magnitude of undernutrition among adult patients with TB was high in the
area. Overall routine appropriate nutrition assessment and support should be given to under­
nourished patients with TB. The level of education about nutrition should be improved by
counseling on a balanced diet to all patients with TB and particularly for female patients.
Appropriate nutrition support should be provided to undernourished TB patients, and more
focused on those who are bedridden.
Keywords: under-nutrition, TB, adult, public health facilities, Jigjiga town, Ethiopia

Introduction
Background
Undernutrition is defined as a condition in which the nutrient and energy intake is
inadequate to meet an individual’s needs to sustain good health.1
Correspondence: Mohamed Omar Osman Individuals become undernourished when their diet does not provide them with
Department of Public Health, College of adequate calories and proteins for maintenance and growth. Illness can further
Medicine and Health Science, Jigjiga
University, P.O. Box: 1020, Jigjiga, Ethiopia result in decreased intestinal absorption.2
Tel +251921424748
Fax +251 25 775 5976
Undernutrition and TB have a complex association. Undernutrition weakens the
Email [email protected] human immune system and this can result in latent TB developing into active infection.

Research and Reports in Tropical Medicine 2021:12 123–133 123

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In turn, TB exacerbates undernutrition by increasing metabolic Nutritional status is important for health and immunity.
demand and decreasing appetite.3 Patients with tuberculosis Cell-mediated immunity is the primary host defense against
face a condition characterized by decreased appetite, nutrient TB; TB is, therefore, a vital risk factor for the development of
intake and micronutrient malabsorption resulting from the undernutrition. Reactivation of previously sub-clinical TB
altered metabolic system of the patients, which is caused by infection is often related to worsening nutritional status.
the disease process. Undernourished patients with TB have Therefore, the effective management of TB requires
delayed recovery and increased death rates in comparison to a detailed assessment of nutritional status since this can help
patients with TB with normal nutrition.4 to manage disease complications and also understand how
Appetite-regulatory hormones are altered in TB nutritional status is likely to impact the disease’s clinical
patients (elevations in Peptide YY2, ghrelin, and resistin course.16
and reductions in plasma leptin). As hormones normalize Addressing undernutrition alongside TB treatment has
during treatment, appetite is restored and nutritional status been shown to improve treatment outcomes, and reduce
improves5 may be associated with low BMI and may the risk of recurrence. Nutritional supplement counseling
account for the poor nutrition linked with TB.6 helps to ensure adequate energy intake, resulting in
According to WHO estimate every year, 10 million people improved which gives a significant improvement in body
fall ill with tuberculosis (TB). Despite being a preventable and weight, total lean mass, and physical functioning.17
curable disease, it causes the death 1.5 million each year – TB programs exist that deliver treatment services to
making it the world’s top infectious killer.7 patients freely in order to control the spread of disease.
More than one-third of the world’s population is Despite these extensive efforts, there are still many under­
infected by M. tuberculosis. The global annual death due nourished adult patients with TB in Ethiopia.15 A recent find­
to TB is estimated to be three million.8 The relationship ing of meta-analysis in Ethiopia showed that more than half of
between undernutrition and TB is evident globally in high, TB patients in were undernourished 50.8% which implicates
middle and low income countries. In the United States of undernutrition of TB patients was noticeably high.18
America, adults who have low Body Mass Index (BMI), In Ethiopia, there are very few reports available on the
reduced subcutaneous fat or reduced skeletal muscle mass prevalence, severity and implications of undernutrition in
of have been shown to be at increased risk of developing adult patients with TB and no reports in Somali regional
TB compared to those with a normal nutritional status.9 state, where the population is geographically, ethnically and
Globally it is estimated that undernutrition causes about culturally different from the population where the available
one-quarter of all new TB cases and tuberculosis is thought to reports were performed. This study aimed to fill this gap by
be one of the most frequent underlying causes of wasting.10 studying the magnitude of undernutrition and associated fac­
In India, undernutrition, and tuberculosis are co-epidemics tors among adult patients with TB in Jigjiga public health
that are viewed as interconnected public health problems; 55% facilities. This information will be used to design targeted
of TB incidence is estimated to be attributable to the effect of interventions that effectively address the problems of under­
undernutrition.11 In Sri Lanka, nutritional status is much lower nutrition in patients with TB in Jigjiga town.
in adult patients with TB than healthy controls and undernutri­
tion doubles the probability of acquiring active TB.12 Sub-
Saharan countries are among the 30 high TB burden countries Methods and Materials
in the world; the number of adults infected by TB infection Study Area and Period
ranges from 10,103 in Congo to 219,156 in South Africa. 90% Jigjiga is the capital city of the Somali Regional State, Ethiopia
of patients with TB are adults of working age, resulting in lost and situated about 630 km east of Addis Ababa. Jigjiga has 20
days of work and a consequent economic burden on these kebeles (Ethiopia’s smallest administration units) in the town
countries.13 In Malawi patients with TB and undernutrition and 10 rural kebeles surrounding the town. There is a regional,
were twice as likely to die early and develop progressive lung hospital, a referral hospital and two health centers which are
disease; undernutrition also increased the risk of developing owned by the government, one private hospital and fifty-eight
TB three-fold.14 private clinics. Government institutions deliver TB services:
In Ethiopia, a country-wide rapid nutrition assessment a total of 830 adult patients with TB were on follow-up,
performed in 2015 found that 2 out of 3 registered adult ranging from 145 in Ayardaga health centre to 300 in Jigjiga
patients with TB had a BMI lower than 18.5 kg/m2.15 City health centre. According to the town’s municipal report of

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2019, Jigjiga has a total population of 884,660, split between Data Collection Procedure
the urban (population = 516,052) and rural (population = Socio-demographic, dietary intake and general health informa­
368,608) kebeles. 97% of the population identify as tion was collected from all eligible participants using
Somali.19 The study was conducted between 1st and 30th a structured questionnaire administered by nurses under the
April, 2020. close supervision of their supervisors. Bodyweight in kilo­
grams (kg) and height in meters (m) were recorded from all
participants except pregnant and lactating mothers; their nutri­
Study Design
tional status was measured using MUAC in millimeters (mm)
Facility-based cross-sectional study design was used.
by the nurses, under the close supervision of the respective
supervisors. Weight was measured using a portable weighing
Inclusion and Exclusion Criteria scale and recorded to the nearest 0.1 kg. During the procedure,
Inclusion Criteria the subjects wore light clothes and were barefoot. Height was
All adult TB patients, who started anti-TB drugs and had measured by using a stadiometer and recorded to the nearest
a follow-up in Jigjiga public health facilities during the study 0.1 cm.20 MUAC was measured for pregnant and lactating
period. mothers by using a non-stretch tape on the non-dominant hand
halfway between the olecranon process and acromion process.
Exclusion Criteria BMI was calculated by dividing weight (in kg) by height
All adult TB patients with a dietary restrictions, or had (in m2). “Underweight” was defined if BMI <18.5 kg/m2;
severely mentally ill and critically ill patients who were “Normal weight” as BMI between 18.5 and 24.9 kg/m2;
unable to communicate. “Overweight” as BMI between 25 and 29.9 kg/m2; “Obese
class I” as BMI between 30 and 34.9 kg/m2, “Obese class II” as
Sample Size Determination BMI between 35 and 39.9 kg/m2; and “Obese class III” as BMI
Sample size was determined based on the double popula­ > 40kg/m2.21 Patient records were reviewed for type and
tion proportion formula and one of three key predictors severity of disease, HIV/AIDS status, stage of TB, and type
from the previous study selected10 and computed by EP of anti-TB medication, duration of anti-TB medication, dura­
INFO version 7. Since the study population is <10,000 tion of cough and other symptoms of TB.
a correction formula was used. The final sample size was =
302 after adding a 10% non-response rate. Study Variables
Dependent Variable
Undernutrition (BMI<18.5 kg/m2 and, or MUAC <210mm
Sampling Technique for pregnant and lactating mothers).
Consecutive sampling technique was used.
Independent Variables
Socio-Demographic Characteristics
Sampling Procedure
Behavior and lifestyle factors, food Intake factors, Disease
Study participants were interviewed consecutively by con­
factors, Eating problems, Functional status.
sidering proportional allocations on the number of patient
flow in each health facility.
Data Quality Control
The data collectors and supervisors were trained to ensure
Data Collection Techniques and Tools familiarity with the questionnaire, and MUAC, weight and
A structured questionnaire was prepared using the concep­ height measurements. Instruments were calibrated prior to
tual framework and information from the literature. use to ensure functionality, accuracy and consistency.
Anthropometric measurements were made using the Patient weight was measured twice and the average of
MUAC measuring tape, stadiometer and digital weighing the two measurements taken.
scales made and utilized by UNICEF. Data collectors with The questionnaire was prepared in English and pretested
previous relevant experience were recruited from health with 2% participants in Kabribayah health centre, which was
facilities and collected data under close supervision by not part of the study, and modifications were made as
a supervisor in each health facility. required. To improve the data quality of the data, the data

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collectors were closely supervised and each completed ques­ Data Processing and Analysis
tionnaire was checked to ascertain that all questions were All collected data were cleaned manually for incompleteness,
properly filled and corrected by the supervisors. coded and entered into Epidata version 3.1 and then exported to
SSPS version 20. Descriptive statistics (frequency distribution,
Operational Definitions proportion, mean and standard deviation) was used to summar­
Undernutrition: This is a condition in which an adult ize variables. All Continuous variables were first transformed
person’s BMI <18.5 kg/m2 or MUAC< 210mm for preg­ into categorical variables before univariate analyzed. Bivariate
nant and lactating mothers.21 and multivariable logistic regression was performed to assess
The FANTA (Food and nutrition technical assistance) the association of variables with undernutrition; variables with
Guide to Anthropometry is a user-friendly reference that a p-value of less than 0.25 in the bivariate analysis were entered
provides update information on anthropometry, the mea­ into the final model. By calculating odds ratios, their 95%
surement of the human body and how to use it to assess confidence limits and P-value less than or equal to 0.05 were
and understand the nutritional status of individuals and taken as statistically significant. All the assumptions of regres­
populations in low resource settings.22 According to sion analysis (model adequacy and multi-co linearity of inde­
FANTA anthropometry, International classification of pendent variables) were checked to be satisfied using
adult nutritional status as (mild, moderate, severe, normal, appropriate methods. The absence of multi-co-linearity was
and overweight). checked by using VIF/tolerance. The model adequacy was
Dietary counseling: This is a process by which a health checked by ensuring Hosmer Lemeshow’s goodness of fit
professional with special training in nutrition helps people test had P-value >0.05.
make healthy food choices and form healthy eating habits.10
Nutritional support: Nutritional support is having Ethical Consideration
numerous components like nutrition education and coun­ Ethical clearance was obtained from the Institutional Review
seling in health facilities, water, and hygiene or food safety Board (IRB) of Jigjiga University based on Helsinki declara­
interventions to avert diarrhea as well as provision of tion and an official letter was given to the respective institu­
sufficient quantity/quality of food and food aid by any tions. Study participants gave written consent confirming that
organization.10 they were informed about the purpose of the study.
Duration of cough and other TB symptoms: The num­
ber of days that a cough or other TB symptoms (such as Results
accidental weight loss, night sweats, loss of appetite or
fever) has lasted before the diagnosis of TB.4
Socio-Demographic Characteristics of
Functional status: Ability to carry out normal daily Adult Patients with TB
activities.10 Out of 302 study participants initially sampled in the study,
Working: Able to carry out normal daily activities and a total of 296 participated, resulting in a response rate of 98%.
no special care needed. Mean age of the study participants was 32 (±SD = 13.243;
Not working: Unable to work but able to live at home range 18–70). The majority of participants were male 153
and able to care for most personal needs but requires (51.7%); Somali 277 (93.6%) and Muslim 282 (95.3%).
occasional assistance. Most participants 181; (61.1%) lived in an urban area with
Bedridden: Unable to care for self, requiring institu­ a family head of father 242 (81.8%). 151 (51%) of participants
tional or hospital care. were married and 155 (52.4%) were illiterate. 78 (26.4%)
Wealth index: Families are given scores based on the participants were students and 158 (53.4%) households had
amount and types of consumer goods they own, extending a family size of between 6 and 10 (Table 1).
from a television to a bicycle or car, in addition to housing
features such as the source of drinking water, toilet facil­ Nutrition Information for Adult Patients
ities and flooring materials. These scores are calculated with TB
using principal component analysis.23 Two hundred and sixteen participants (73%) had received
Severe thinness, moderate thinness, and mild thin­ dietary counseling from a health professional that was
ness is a BMI< 16kg/m2, 16–16.99 kg/m2 and 17– treating them and only 5 (1.7%) participants had received
18.49 kg/m2.21 nutritional support. The majority of respondents 209

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Table 1 Socio-Demographic Characteristics of Adult Patients Table 1 (Continued).

with TB in Jigjiga Public Health Facilities, Somali Region, Eastern
Ethiopia, April 2020 Variable Category Frequency Percent

Variable Category Frequency Percent Occupation Government 33 11.1

employee
Age 18–27 126 42.6
Farmer 69 23.3
28–37 68 23
House wife 64 21.6
38–47 51 17.2
Student 78 26.4
≥48 51 17.2
Merchant 2 0.7
Marital status Single 126 42.6
Daily labor 27 9.1
Married 151 51
Driver 2 0.7
Widowed 15 5.1
Jobless 21 7.1
Separated 4 1.4
Wealth index Poor 139 47.0
Pregnancy and Pregnant 4 1.4
lactation Medium 44 14.9
Lactating 10 3.4
Rich 113 38.2
Family size 0–5 115 38.9

6–10 158 53.4

>10 23 7.8 (70.6%) consumed a meal three times daily while 22

Family head Father 242 81.8 (7.4%), 52 (17.6%), and 13 (4.4%) consumed a meal
once daily, twice daily or more than four times daily,
Mother 33 11.1
respectively. Based on the source of food consumed, 7
Brother 5 1.7 (2.4%) received their food as a gift, 21 (7.1%) ate their
Sister 2 0.7 own product and 268 (90.5%) purchased their food from
Son 8 2.7
the market. Most participants 183 (61.8%) did not practice
dietary diversity (Table 2).
Daughter 2 0.7

Uncle 4 1.4
Behavior and Lifestyle of Adult Patients
Religion Muslim 282 95.3
with TB
Protestant 2 0.7 Almost eighty percent of participants did not use sub­
Orthodox 12 4
stances (chew Khat, smoke cigarettes or drink alcohol)
while 7%, 12% and 1% were currently cigarette smokers,
Ethnicity Somali 277 93.6
Khat chewers and alcohol drinkers respectively (Figure 1).
Amhara 12 4.1

Oromo 6 2 Health Status of Adult Patients with TB

Debub 1 0.3 The overall prevalence of undernutrition among adult TB
patients was 44.3% [95% CI (38.2, 49.7)] Ninety-eight
Educational Illiterate(cannot read 155 52.4
status and write)
(34.1%) participants had a cough for more than four weeks
before being diagnosed with TB and 89 (30.1%) had con­
Literate 141 47.6
current breathing difficulties. Moreover, 52 (17.6%) had
(Continued) problems with eating from which 35 (11.8%), 13 (4.4%)

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Table 2 Nutrition Information of Adult Patients with TB in Jigjiga participants 210 (70.9%), 70 (23.6%) and 16 (5.4%) were
Public Health Facilities, Somali Region, Eastern Ethiopia, April, 2020 working, ambulatory and bedridden, respectively (Table 3).
Variable Category Frequency Percent

Received dietary Yes 216 73.0 Records from Health Facilities

counselling Over half 167 (56.4%) of the respondents were patients with
No 80 27.0
pulmonary TB and 252 (85.1%) were new cases. Over half 158
Received nutritional Yes 5 1.7 (53.4%) had been prescribed rifampicin and isoniazid, and 154
support
No 291 98.3 (52%) patients had been taking anti-TB medication for more
Number of meals One 22 7.4
than four weeks. Six (2%) were HIV positive (Table 4).
daily
Two 52 17.6
The Magnitude of Undernutrition Among
Three 209 70.6
Adult Patients with TB Based on FANTA
Four or more 13 4.4
Classification
Food source Own product 21 7.1 According to FANTA anthropometry, 2018 International
Market purchase 268 90.5 classification of adult nutritional status (mild, moderate,
severe, normal, and overweight), the current result
Gift 7 2.4
revealed that out of those undernourished, 25 (8.4%)
Dietary diversity Yes 113 38.2 were severe, 26 (8.8%) were moderate and 80 (27%)
practiced were mildly undernourished but 13 (4.4%) of the respon­
No 183 61.8
dents were overweight ie BMI > 25kg/m2 (Figure 2).

Multivariate Logistic Regression Analysis

and 1 (0.3%) were caused by poor appetite, nausea or vomit­
ing and mouth ulcer, respectively. For the last two weeks or
of Factors Associated with
a month before data collection, 33 (11.1%) of the respon­ Undernutrition Among Adult Patients
dents have been ill other than TB, 20 (6.8%), 9 (3.0%) and 4 with TB
(1.4%) had gastritis, diarrheal disease and diabetes mellitus, In a multivariable logistic regression analysis, female
respectively. According to the functional status of the patients with TB were approximately two times more

Figure 1 Behavior and lifestyle of adult patients with TB.

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Table 3 Health Status of Adult Patients with TB in Jigjiga Public Table 4 Record Review of Adult Patients with TB in Jigjiga Public
Health Facilities, Somali Region, Eastern Ethiopia, April, 2020 Health Facilities, Somali Region, Eastern Ethiopia, April, 2020
Variable Category Frequency Percent Variable Category Frequency Percent

Nutritional status Undernourished 131 44.3 Duration of cough prior to One week 51 17.2
the diagnosis of TB
Normal 165 55.7 Two weeks 70 23.6

Type of TB Pulmonary TB 167 56.4 Three 74 25.0

weeks
Extra-pulmonary TB 114 38.5
More than 101 34.1
MDR TB 15 5.1
four weeks
TB treatment New case 252 85.1
Difficult breathing co- Yes 89 30.1
Previous history of 44 14.9 morbidity of the patient
No 207 69.9
TB treatment
Difficulty eating Yes 52 17.6
HIV/AIDS status Positive 6 2
No 244 82.4
Negative 290 98
Reason for difficulty eating Mouth 1 0.3
The type of anti- RHZE 123 41.6
ulcer
TB treatment
RH 158 53.4
Poor 35 11.8
Linezolid, 7 2.4 appetite
pyrazinamide,
Nausea or 13 4.4
cycloserine
vomiting
Cycloserine, 8 2.7
Swallowing 3 1.0
levofloxacin,
difficult
linezolid
Other Illness for the last 2 Yes 33 11.1
Duration of anti- <four weeks 142 48
weeks/months
TB treatment No 263 88.9
>four weeks 154 52
Type of illness Diarrheal 9 3.0
disease
likely to be undernourished than male patients Diabetes 4 1.4
[AOR=1.769, CI=1.035, 3.024]. Respondents who were mellitus
illiterate were nearly four times more likely to be under­
Gastritis 20 6.8
nourished compared to those who were literate
[AOR=3.939, CI=2.285, 6.792]. Bedridden patients with Functional status of the Working 210 70.9
patient
TB were nearly four times more likely to have undernutri­ Ambulatory 70 23.6
tion relative to those who were working and ambulatory
Bed ridden 16 5.4
[AOR=3.718, CI=1.115, 12.394] (Table 5).

Discussion
This study found that more than forty percent of partici­ may also contribute to the disparity. For example, in the
pants with TB were undernourished. Moreover, gender, study in Brazil, patients with TB over 60 years’ old were
educational status and functional status were factors sig­ excluded; while in the Sri Lanka study participants were
nificantly associated with undernutrition among adult aged between 80 and 100; these disparities in age groups
patients with TB. The number of undernourished adults may have a confounding effect on nutrition. The preva­
in this study (44.3%) was less than from studies from lence from our study was also lower than seen in West
Brazil (50%)24 and Sri-Lanka (51%).12 This may be due Tripura (59.1%) and north Karnataka in India (55.8%).25,26
to socio-economic, behavioral and lifestyle differences. In This may be due to the socio-cultural difference of the
addition, the methodological approaches of these studies respondents; moreover, participants of studies in India had

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Figure 2 Magnitude of undernutrition among adult patients with TB based on FANTA classification.

higher rates of co morbidityfor example, HIV/AIDS and might deliver similar services to the participants as in our
diabetes mellitus. study.
Compared to other studies in Africa, prevalence was Female patients with TB were 1.77 times more likely to
also shown to be lower than that of studies conducted in be undernourished when compared to male patients with TB.
Zambia (57%)27 and Malawi (51%).28 This could be due This is in line with another study done in Adama, Ethiopia.31
to socio-cultural, behavioral and lifestyle differences. This could a higher number of female patients who were
Additionally, these studies included only newly diagnosed subjected to social bias compared with male patients, which
patients with TB whereas our study included patients who could compromise their ability to put nutritional counseling
were on anti-TB medication and had to follow up. Anti-TB given to them by their treating clinicians or health profes­
medication may have an impact on the nutritional status of sionals into action. This argument strengthened by
patients. The WHO report in 2019 which indicated that,
Two studies in Ethiopia have also reported higher rates worldwide, the male to female ratio was 2:1 among
of concurrent undernutrition among adult patients with TB patients with TB.32 In addition, more female patients
(57.2%)29 and (63.2%)30 which again are higher than we were excluded in social-economic and health opportu­
report. This could be due to the high number of partici­ nities in the African context which might lead to less
pants from rural areas, where there may be less access to access to health care, balanced nutrition, safe water and
health care and nutrition-rich food. In addition, over half sanitation.
of the respondents of these studies had TB symptoms for This study found an association between undernutrition
more than four weeks prior diagnosis and (11.6%) had co and education, as illiterate patients with TB were nearly
morbidities, for example kidney disease, cardiovascular four times more likely to be undernourished compared to
disease and asthma, which might have an effect on their those who were literate. This finding is supported by
nutrition. a study conducted in north Karnataka, India that declared
Two studies performed in Hosanna and Addis Ababa illiterate patients with TB were more likely to be under­
public health facilities identified a prevalence of under­ nourished than those who were literate.25,33 Those with
nutrition in TB patients of 38.90%4 and 39.7%,10 respec­ lower levels of literacy may have less understanding about
tively, which are in line with this study’s results. This may dietary diversity and anti-TB adherence.
be due to the similar methods used. Furthermore, these Our study stated that there is a significant association
studies were carried out in health centers and hospitals that between undernutrition and functional status which is

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Table 5 Factors Associated with Undernutrition Among Adult Patients with TB in Jigjiga Public Health Facilities, Somali Region,
Eastern Ethiopia, April, 2020
Variables Category Undernutrition COR (95% CI) AOR (95% CI) P-value

Yes (%) No (%)

Sex Male 58(19.6) 95(32.09) 1.00 1.00

Female 73(24.7) 70(23.65) 1.7(1.1,2.71) 1.77(1.04,3.02) 0.037*

Residence Urban 69(23.3) 112(37.8) 1.00 1.00

Rural 62(20.95) 53(17.91) 1.9(1.18,3.05) 1.03(0.59,1.81) 0.914

Educational status Illiterate 61(39.4) 94(60.6) 4.33(2.6,7.1) 3.94(2.29,6.79) 0.000*

Literate 104(73.8) 37(26.2) 1.00 1.00

Smoking cigarette Yes 14(4.73) 7(2.36) 2.7(1.06,6.9) 1.93 (0.58,6.38) 0.282

No 117(39.5) 158(53.4) 1.00 1.00

Chewing khat Yes 20(57.1) 15(42.9) 1.8(0.9,3.7) 1.2(0.46,3.14) 0.710

No 111(42.5) 150(57.5) 1.00

Eating problem Yes 28(53.8) 24(46.2) 1.597(0.875,2.914) 1.09(0.53,2.27) 0.810

No 103(42.2) 141(57.8) 1.00

Dyspneoa Yes 47(52.8) 42(47.2) 1.7(0.99,2.7) 0.76(0.4,1.46) 0.406

No 84(40.6) 123(59.4) 1.00

Illness for the last 2 weeks/a month Yes 18(6.1) 15(5.1) 1.6(0.77,3.29) 1.28(0.56,2.94) 0.554

No 113(38.2) 150(50.7) 1.00

Functional status Working 81(38.6) 129(61.4) 1.00

Ambulatory 39(55.7) 31(44.3) 2(1.16,3.46) 1.48(0.74,2.9) 0.268

Bedridden 11(68.8) 5(31.2) 3.5(1.17,10.45) 3.72(1.12,12.4) 0.033*

Duration of cough prior to the diagnosis One week 19(37.3) 32(62.7) 1.00

Two weeks 23(32.9) 47(67.1) 0.82(0.39,1.76) 0.75(0.32,1.75) 0.508

Three weeks 36(48.6) 38(51.4) 1.5(0.77,3.3) 1.597(0.71,3.6) 0.259

More than 4 53(52.5) 48(47.5) 1.86(0.93,3.70) 1.54(0.71,3.34) 0.279

Note: *Significant P=<0.05.

consistent with another similar study done in Addis Limitation of the Study
Ababa.10 Bedridden patients with TB were nearly four There were questions allocated to assess behavior and lifestyle
times more likely to be undernourished compared to factors that might subject to social desirability bias. Moreover,
those who were working. The functional status of patients the study was unable to relate undernourished patients with TB
is commonly associated with their primary medical situa­ to the nutrition centre due to lack of nutrition supply.
tion, and patients with worse functional status often have Appetite mediators were not evaluated. Half of the
a poorer health status.34 This situation may result in patients had been on therapy for >1 month yet therapy
reduced eating of food which may in turn cause improves nutritional status; this could underestimate the
undernutrition. prevalence of undernutrition.

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Conclusion 13. Annabel B, Anna D, Hannah M.Global Tuberculosis Report; Geneva:

World Health Organization; 2019.
The study reports a high prevalence of undernutrition 14. Papathakis P, Piwoz E. Nutrition and Tuberculosis: A Review of the
among adult patients with TB in Jigjiga public health Literature and Considerations for TB Control Programs. United
States Agency for International Development, Africa’s Health 2010
facilities. Factors significantly associated with undernutri­
Project; 2008:1.
tion were sex, educational status and functional status. 15. Bekele A. Guidelines for management of TB, DR-TB and Leprosy in
Education about nutrition should be improved to include Ethiopia. Federal Democratic Republic of Eethiopia Ministry of
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knowledge and dietary counseling of balanced diet. These 16. Dodor EA. Evaluation of nutritioal status of tuberculosis patiets at the
programs should be targeted for female patients. effia-kwata regioal hospital. Ghana Med J. 2008;42(1):22–28.
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given to undernourished patients with TB, female patients doi:10.1080/10408398.2012.679500
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nutrition among adult tuberculosis patients in Ethiopia: a systematic
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Disclosure 22. Cogill BAIMG. Anthropometric Indicators Measurement Guide.
The authors reported no conflicts of interest for this work. Washington, DC: FHI 360/FANTA; 2003.
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