The prevalence of hazardous alcohol drinking among patients with tuberculosis in the current study was found to be 20% (95 % CI = 16.1–24.2). The current estimate is lower than the studies conducted in Botswana, Lesotho, India and Thailand (24.7%, 35.1%, 29% 32% and 24.4% (10, 19-22). This might be because of difference in study setting, study deign, study year, socio-demographic and type of screening tool used.
Even though all studies from Botswana, South India and Lesotho used AUDIT that might make it similar with the current study, the population, year of study and the socio-demographic difference might account for the difference. The estimate of the current study is consistent with studies reported from South Africa, Scotland and USA (23.3%, 23.2%, 18% and 17.9% respectively (23-26).
On the other hand, the estimate of the current study is by far higher than one study conducted in USA (15.1%) (27). The tool used for measuring hazardous alcohol drinking, and the cutoff point used to categorize the patients' alcohol use behavior is completely different from the current study. On top of that, the study design, study time and setting at which the current data was collected could be considered as a source of variation in estimation between the current and compared study.
The current study also identified different factors that had an association with hazardous alcohol drinking among patients with TB. Sex of the participant was one of the factors that had a significant association with hazardous alcohol drinking. The risk of hazardous alcohol drinking for men participants was higher as compared to women. This might be due to the biological differences in reactions to alcohol use, and that gender differences in alcohol use behavior may be modified by psychosocial and cultural factors (5, 28-30). The study result is consistent with an institution based cross-sectional studies from Namibia, Lesotho, India and, Scotland (19, 22, 25, 31).
The other factor that had a significant association with hazardous alcohol drinking was the duration of illness. The odd of hazardous alcohol drinking was 2.88 times higher among those who had longer duration of illness as compared to those who had less than 6 months of illness duration. A systematic review conducted on the association between alcohol use, alcohol use disorders and tuberculosis reported a risk of alcohol use for TB treatment outcome and vice versa (32).
Alcohol use has a negative impact on the clinical course of TB (33, 34). People drinking alcohol show higher relapse rates, a higher probability of poor clinical outcome, and a higher probability of experiencing Multi-Drug Resistant-TB (35-37).
The other factor, which increased the odd of hazardous alcohol drinking was medical comorbidity, HIV/AIDS and other chronic disease. Those who had comorbid medical conditions were 2.44 times at higher risk of being hazardous alcohol user as compared to patients without medical comorbidity (30). So far, the current finding is supported by WHO, global status report on alcohol and health 2018 (5). This might be because of the fact that having medical comorbidity will increase stress and other psychological problems.
Unlike other studies, the current study did not find any association between hazardous alcohol drinking, and; age of the participant, marital status, depressive symptoms, social support and category of TB treatment.
The strengths and limitations of the study
Our study has two major strengths. First, the study assessed hazardous alcohol drinking, which was not previously studied. Second, validated and standardized tools were used to assess hazardous alcohol drinking and independent variables.
Since the cross-sectional study design could not establish clear risks of hazardous alcohol drinking among patients with tuberculosis, it was difficult to imply the temporal relationship between significantly associated factors and hazardous alcohol drinking. In addition to this, the authors did not consider other mental health issues that can confound study outcome. For instance, the presence of severe mental illness and tobacco use, which are commonly associated with alcohol use. Therefore, we recommend further studies to focus on tobacco use and comorbid severe mental health disorders.