Socio demographic characteristics of TB-HIV co-infected adults by anemia status
Regarding the baseline socio-demographic characteristics, 148 of 305 (48.5%) of the participants were males with a median (IQR) age and hemoglobin of 35 (IQR: 29 - 40 years), and 11.9 (IQR: 10.3-13.5 g/dl), respectively. Moreover, 69 of 305 (22.6%) had single marital status, 65 of 305 (21.5%) were with no education, 293 of 305 (96.1%) were orthodox followers, 222 of 305 (72.8%) were residents of Mekelle city, and 172 of 305 (56.4 %) had initiated ART service in Mekelle hospital. Based on their anemia status, 65 of 157 (41.4%) females, 43 of 129 (33.3%) married adults, 40 of 129 (33.6%) with secondary educational status, and 9 of 12 (75.0%) Muslims were anemic at baseline (Table 1).
Table 1: Baseline Socio-demographic characteristics and anemia status of TB-HIV co-infected adults of ART naïve from September, 2009 to December, 2016 in Mekelle, Ethiopia (n = 305)
Socio-demographic Characteristic
|
|
|
Baseline level of Anemia Status
|
|
Prevalence rate (number of anemia cases per 100 TB-HIV adults )
|
|
Normal
(n=125)
Count (%)
|
Mild anemia
(n=75)
Count (%)
|
Moderate anemia (n=86)
Count (%)
|
Severe anemia (n=19)
Count (%)
|
Number of TB-HIV cases (%)
|
P-value
|
Sex
|
|
|
|
|
|
|
0.001
|
Male
|
47 (37.6)
|
57 (76.0)
|
37 (44.0)
|
7 (36.8)
|
148 (48.5)
|
68.2
|
|
Female
|
78 (62.4)
|
18 (24.0)
|
49 (56.0)
|
12 (63.2)
|
157 (51.5)
|
50.2
|
|
Baseline Age (Median & IQR) 35 (29 -40) years
|
0.320
|
Educational Status
|
0.194
|
No education
|
25(20.0)
|
15 (20.0)
|
21 (24.4)
|
4 (21.1)
|
65 (21.3)
|
61.5
|
|
Primary
|
30 (24.0)
|
24 (32.0)
|
31 (36.0)
|
5 (26.3)
|
90 (29.5)
|
66.7
|
|
Secondary
|
57 (45.6)
|
24 (32.0)
|
28 (32.6)
|
10 (52.6)
|
119 (39.0)
|
52.1
|
|
Tertiary
|
13 (10.4)
|
12 (16.0)
|
6 (7.0)
|
0 (0.0)
|
31 (10.2)
|
58.1
|
|
Marital Status
|
0.639
|
Single
|
30 (24.0)
|
14 (18.7)
|
21 (24.4)
|
43 (22.5)
|
69 (22.6)
|
56.5
|
|
Married
|
55 (44.0)
|
34 (45.3)
|
30 (34.9)
|
86 (45.0)
|
129 (42.3)
|
57.4
|
|
Othersa
|
40 (32.0)
|
27 (36.0)
|
35 (40.7)
|
62 (32.5)
|
107 (35.1)
|
62.6
|
|
Religion
|
|
|
|
|
|
|
0.251
|
Orthodox
|
122 (97.6)
|
72 (96.0)
|
83 (96.5)
|
16 (84.2)
|
293 (96.1)
|
58.4
|
|
Muslim
|
3 (2.4)
|
3 (4.0)
|
3 (3.5)
|
3 (15.8)
|
12 (3.9)
|
75.0
|
|
Place of residence
|
|
|
|
|
|
|
0.797
|
Mekelle
|
90 (72.0)
|
51 (68.0)
|
69 (80.2)
|
12 (63.2)
|
222 (72.8)
|
59.5
|
|
Outside Mekelle
|
35 (28.0)
|
24 (32.0)
|
17 (19.8)
|
7 (36.8)
|
83 (27.2)
|
57.8
|
|
ART follow up site
|
0.003
|
|
ACSH
|
42 (33.6)
|
42 (56.0)
|
39 (45.4)
|
10 (52.6)
|
133 (43.6)
|
68.4
|
|
Mekelle hospital
|
83 (66.4)
|
33 (44.0)
|
47 (54.6)
|
9 (47.4)
|
172 (56.4)
|
51.7
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Othersa:Widowed/Divorced/Separated ACSH: Ayder Comprehensive Specialized Hospital IQR: Interquartile Range
Clinical characteristics of TB-HIV co-infected adults by anemia status
Based on the clinical characteristics, 141 (46.2%) and 142 (46.6%) of TB-HIV co-infected adults had baseline working functional status, and WHO clinical stage. In addition, 132 (43.3%) of TB cases were involved the lung (diagnosed with PTB) where the median baseline BMI (kg/m2), and CD4+ cell count (cells/mm3) were kept at 17.4 and 86, respectively. Regarding the outcome status, 49 of 110 (45.5%) TB-HIV adults with baseline ambulatory functional status, 61 of 142 (43.3%) adults with baseline clinical stage IV and 69 of 173 (39.9%) EPTB or mixed – HIV co-infected adults had anemia at the time of ART initiation (Table 2).
Table 2: Baseline clinical characteristics and anemia status of TB-HIV co-infected adults of ART naïve from September, 2009 to December, 2016 in Mekelle, Ethiopia (n = 305)
Baseline clinical Characteristics
|
|
|
Baseline level of Anemia Status
|
|
Prevalence rate (number of anemia cases per 100 TB-HIV adults )
|
P-value
|
Normal
(n=125)
Count (%)
|
Mild anemia
(n=75)
Count (%)
|
Moderate anemia (n=86)
Count (%)
|
Severe anemia (n=19)
Count (%)
|
Number of TB-HIV cases (%)
|
Functional status
|
|
|
|
|
|
|
<0.001
|
Working
|
76 (60.8)
|
33 (44.0)
|
28 (32.6)
|
4 (21.1)
|
141 (46.2)
|
46.1
|
Ambulatory
|
34 (27.2)
|
30 (40.0)
|
39 (45.3)
|
7 (36.8)
|
110 (36.1)
|
69.1
|
Bedridden
|
15 (12.0)
|
12 (16.0)
|
19 (22.1)
|
8 (42.1)
|
54 (17.7)
|
72.2
|
|
BMI (Mean±sd) 17.4 (15.6 – 19.3 kg/m2)
|
<0.001
|
Serum ALT (Median & IQR) 34.5 (24.0 – 51.0 U/L)
|
0.871
|
Serum AST (Median & IQR) 40.0 (28.0 – 60.0 U/L)
|
0.104
|
WHO clinical stage
|
<0.001
|
I/II
|
30 (24.0)
|
14 (18.7)
|
3 (3.5)
|
0 (0.0)
|
30 (10.5)
|
28.1
|
|
III
|
55 (44.0)
|
34 (45.3)
|
38 (44.2)
|
6 (31.6)
|
131 (42.9)
|
57.3
|
|
IV
|
40 (32.0)
|
27 (36.0)
|
45 (52.3)
|
13 (68.4)
|
142 (46.6)
|
67.6
|
|
CD4 Cell Count
|
|
|
|
|
|
|
<0.001
|
<=200 Cells/mm3
|
90 (72.0)
|
64 (85.3)
|
79 (91.9)
|
17 (89.5)
|
250 (82.0)
|
64.0
|
|
>200 Cells/mm3
|
35 (28.0)
|
11 (14.7)
|
7 (8.1)
|
2 (10.5)
|
55 (18.0)
|
36.4
|
|
TB Infection Site
|
|
|
|
|
|
|
0.063
|
PTB
|
62 (49.6)
|
29 (38.7)
|
36 (41.9)
|
5 (26.3)
|
132 (43.3)
|
53.0
|
|
EPTB/Mixed type
|
63 (50.4)
|
46 (61.3)
|
50 (58.1)
|
14 (73.7)
|
173 (56.7)
|
63.6
|
|
|
|
|
|
|
|
|
|
|
|
ALT: Alanine Transferase AST: Aspartate Transferase PTB: Pulmonary Tuberculosis, EPTB: Extra Pulmonary Tuberculosis BMI: Body Mass Index IQR: Interquartile range
Prevalence of Anemia among TB-HIV co-infected adults
Based on the baseline hemoglobin measurement (g/dl or g %) of TB-HIV co-infected adults, 180 of 305 (prevalence rate = 59.0%; 95% CI: 53.3 – 64.6%) were anemic. Furthermore, the prevalence’s of mild, moderate and severe anemia were 24.6%, 28.2% and 6.2%, respectively at baseline (Fig.1). Comparatively, the prevalence of anemia was varying across the different categories of the baseline socio-demographic and clinical characteristics of adults co-infected with dual burdens of TB and HIV co-infections (Tables 1 and 2).
Determinants of anemia among TB-HIV co-infected adults
Upon running the final multiple logit regression analysis, the baseline determinants of anemia were: Sex, functional status, WHO clinical stage, and BMI (kg/m2). Keeping other variables constant, female TB-HIV co-infected adults of ART naïve were 0.379 (Adj.OR = 0.379; 95% CI: 0.226 – 0.635) times less likely to develop anemia than male adults (i.e. being a male TB-HIV co-infected adult protects approximately 62% against anemia). Like wisely, the changes in odds of developing anima among TB-HIV co-infected adults with baseline ambulatory functional status, bedridden functional status, WHO clinical stage III and IV were approximately 130%, 140%, 200% and 210%, respectively as compared to their reference categories. However, a unit increase in BMI (1 kg/m2) reduces the occurrence of anemia by 10% (Adj. OR = 0.897, 95% CI: 0.823 - 0.977) in TB-HIV co-infected adults (Table 3).
Table 3: statistically significant determinants of anemia among TB-HIV co-infected adults of ART naïve from September, 2009 to December, 2016 in Mekelle, Ethiopia (n = 305)
Independent variables
|
Category
|
Adj.OR
|
Standard Error
|
95% CI
|
P-value
|
2.5% (LL)
|
97.5% (UL)
|
Sex
|
Male
|
1.000
|
Female
|
0.379
|
0.100
|
0.226
|
0.635
|
<0.001**
|
BMI (kg/m2)
|
0.897
|
0.039
|
0.823
|
0.977
|
0.013*
|
Functional status
|
Working
|
1.000
|
Ambulatory
|
2.302
|
0.677
|
1.293
|
4.097
|
0.005**
|
Bedridden
|
2.352
|
0.940
|
1.074
|
5.149
|
0.032*
|
WHO Clinical stage
|
I or II
|
1.000
|
III
|
2.987
|
1.358
|
1.226
|
7.279
|
0.016*
|
IV
|
3.056
|
1.432
|
1.219
|
7.657
|
0.017*
|
Intercept
|
3.980
|
3.782
|
0.618
|
25.626
|
0.146
|
Adj. OR: Adjusted Odds Ratio BMI: Body Mass Index CI: Confidence Interval LL: lower Limit UL: Upper Limit 1.000: Reference category *: significant at 5% level of significance **: significant at 1% level of significance