Nutritional status of patients with tuberculosis and TB/HIV co-infection at Standerton TB specialised hospital, Mpumalanga

[摘要] English: Tuberculosis (TB) is a leading cause of morbidity and mortality, especially in middle- and low-income countries. Globally, an estimated 2 billion people are infected with TB, of which 1 billion are malnourished. TB is strongly influenced by nutritional status, with nutrition interventions being likely to impact on prevalence of active disease, response to drug therapy and quality of life.The aim of this study was to determine the nutritional status of patients with TB and TB/HIV co-infection. A convenience sample of a 100 hospitalised patients in Standerton TB Specialised Hospital, Mpumalanga, were included (60 men and 40 women). Socio-economic status, nutritional status (focusing on eating related side effects, food security, anthropometric measurements, overall risk of malnutrition and biochemical parameters), and lifestyle behaviours (smoking habits and alcohol use), as well as associations between the above were determined.Food security was determined by means of the Community Childhood Hunger Identification Project (CCHIP) tool (that includes questions related to food insecurity, food shortages, perceived food insufficienty or altered food intake due to constraints on resources). Weight and height were obtained to calculate body mass index (BMI), while mid-upper arm circumference (MUAC) and triceps skinfold were taken to determine malnutrition and muscle wasting. The overall risk of malnutrition was determined by means of the Malnutrition Universal Screening Tool (MUST) (which calculates the overall risk of malnutrition by making use of a BMI score, a weight loss score and an acute disease score). Biochemical parameters were recorded from patient files. Socio-economic status included gender, age, marital status, education level, employment status, household income and housing density. Lifestyle factors included smoking habits and alcohol use. These variables were determined by means of a questionnaire completed by the researcher in a structured interview with each participant.The majority of participants (91%) did not complete matric and two thirds (66%) were unemployed. More than one out of ten participants (12%) indicated that they had no monthly income and in 64% of households, only one person contributed to the monthly income. Room density of more than 2.5 persons per room (crowded) was present in 29% of households. Only 26% of participants reported having a household vegetable garden. As far as household food security was concerned, only 3% were classified as food secure with 27% of households being at risk of hunger and 70% being food insecure (hungry).The food related side effects reported most commonly included loss of appetite (59%) followed by dry mouth (48%). According to the MUST, the overall risk for malnutrition was as follows: 70% had a high risk, 22% had a medium risk and 8% had a low risk. Actual unplanned weight loss and percentage of unplanned weight loss were significantly higher in patients with TB and HIV co-infection than in patients with TB only (95%CI [1.5%; 38.2%] and [5.3%; 51.0%] respectively). Median BMI was in the underweight category at 18.3 kg/m². Half of participants (51%) had a MUAC in the low category, while half (49.9%) had triceps skinfold measurements below the 15th percentile, indicating malnutrition. The majority of participants had albumin and haemoglobin values below the normal ranges (79% and 92% respectively).Almost six out of ten participants (58%) indicated that they were former (44%) or current (14%) smokers. The average cigarettes, pipes or cigars smoked by the former and current smokers were 4 with a maximum of 20 per day. The average amount of years that the former or current smokers smoked was 9 years with a minimum of 1 year and a maximum of 30 years. Nearly half of participants (49%) reported that they did use alcohol with 25% drinking alcohol more than three times per week. Statistically significantly more females than males were non-smokers and more men drank alcohol three times or more per week than females. Participants that indicated that they were either former or current smokers had significantly lower levels of education than participants who were non-smokers (95% CI [-26.7%; -2.6%] and [-39.9%; -1.0%] respectively). There were no statistically significant differences in terms of BMI in smokers versus non-smokers.In the present study, the nutritional status of patients with TB and TB/HIV co-infection was found to be poor. They were characterised by poor socio-economic status, high levels of food insecurity, malnutrition (underweight, anaemia and hypoalbuminaemia) and poor lifestyle habits (smoking and alcohol use).Recommendations to address the poor nutritional status of patients with TB and TB/HIV co-infection should include relief of poverty in communities, a focus on relevant and culturally acceptable nutrition education and the establishment of sustainable support networks.

[发布机构] University of the Free State