A total of 5045 study participants were included giving for the response rate of 93.1 %, 286 study participants did not volunteer to participate and 87 study participants were excluded due to incomplete data. The mean age of the study participants was 28 years (standard deviation [SD] ±14 years), 18 years was the young age of study participants, 1681 of the study participants was TB patients and 3364 of the study participants were TB free residents. Female constitute 53.9 % (2721) of the study participants, 26% of the study participants were from the urban area, 90% of the study participants were Amhara by ethnicity and 96.7% of the study participants were Orthodox Christian believers.
Profile of TB patients
A total of 1681 TB patients were included giving for the response rate of 93 %. The mean age of the study participants was 27.78 years (SD ±13.98 years), 42.3 % of TB patients were from the urban area and 76.8 % of TB patients were pulmonary TB patients (Table 1).
Table 1: Profile of TB patients (n=1681).
S[i][1]
|
Population profile
|
Frequency
|
Percentage
|
Normal
|
Underweight
|
Frequency
|
Percentage
|
Frequency
|
Percentage
|
1.
|
Sex
|
Male
|
1162
|
69.1
|
527
|
31.4
|
633
|
37.8
|
Female
|
519
|
30.9
|
193
|
11.3
|
327
|
19.4
|
2.
|
Residence
|
Urban
|
711
|
42.3
|
218
|
13
|
493
|
29.3
|
Rural
|
970
|
57.7
|
502
|
29.9
|
468
|
27.8
|
3.
|
Site of infection
|
Pulmonary tuberculosis
|
1297
|
76.8
|
556
|
33.1
|
735
|
43.7
|
Extra-pulmonary TB
|
390
|
23.2
|
164
|
9.8
|
226
|
13.4
|
4.
|
HIV status
|
Positive
|
595
|
35.2
|
307
|
18.3
|
285
|
17
|
Negative
|
1089
|
64.8
|
339
|
20.2
|
676
|
40.2
|
5.
|
Income in birr[2]
|
<1000
|
1170
|
69.6
|
463
|
27.5
|
707
|
42.1
|
1000-2000
|
316
|
18.8
|
186
|
11.1
|
130
|
7.7
|
≥2001
|
195
|
11.6
|
71
|
4.2
|
124
|
7.4
|
6.
|
Occupation
|
Farmer
|
835
|
49.7
|
407
|
24.2
|
428
|
25.5
|
Others
|
846
|
50.3
|
313
|
18.6
|
533
|
31.7
|
7.
|
Family size
|
≤4
|
648
|
38.5
|
499
|
29.7
|
149
|
8.9
|
>4
|
1033
|
61.5
|
221
|
13.1
|
812
|
48.3
|
8.
|
Marital status
|
Single
|
694
|
41.3
|
278
|
16.5
|
416
|
24.7
|
Married
|
966
|
57.5
|
427
|
25.4
|
539
|
32.1
|
Divorced
|
18
|
1.1
|
14
|
0.8
|
4
|
0.2
|
Widowed
|
3
|
0.2
|
1
|
0.1
|
2
|
0.1
|
9.
|
Anemia
|
Present
|
1488
|
88.5
|
654
|
38.9
|
834
|
49.6
|
Absent
|
193
|
11.5
|
66
|
3.9
|
127
|
7.6
|
10.
|
Age
|
<25
|
1350
|
80.3
|
513
|
30.5
|
837
|
49.8
|
≥25
|
331
|
19.7
|
207
|
12.3
|
124
|
7.4
|
11.
|
Intestinal parasitic infection
|
Ascaris Lumbricoides
|
409
|
24.3
|
82
|
4.9
|
327
|
19.5
|
Hookworm
|
282
|
16.8
|
112
|
6.7
|
170
|
10.1
|
Strongloid stercolaris
|
75
|
4.5
|
19
|
1.1
|
56
|
3.3
|
Others
|
127
|
7.6
|
22
|
1.3
|
105
|
6.2
|
Not infected
|
788
|
46.9
|
485
|
28.9
|
303
|
18
|
[1] SN=serial number
[2] 1 US dollar =23 birr
The prevalence of underweight among TB patients was 57.17 % (95% CI: 54.80 % -59.54 %), 88.52 % of TB patients were anemic (95% CI: 86.99 %- 90.04 %) and 48.25% (718) of anemia was iron deficiency anemia (Table 2).
Table 2: The type of anemia among TB patients (n=1488)
|
Mean corpuscular volume (MCV)
|
Total
|
Malnutrition
|
|
Normocytic
|
Microcytic
|
Macrocytic
|
Norma
|
Underweight
|
No.
|
Frequency
|
Percentage
|
Frequency
|
Percentage
|
Mean corpuscular hemoglobin concentration (MCHC)
|
Normochromic
|
672
|
15
|
6
|
693
|
282
|
19
|
411
|
27.6
|
Hypochromic
|
15
|
718
|
4
|
737
|
353
|
23.7
|
384
|
25.8
|
Hyperchromic
|
14
|
12
|
32
|
58
|
19
|
1.3
|
39
|
2.6
|
Total
|
No.
|
701
|
745
|
42
|
1488
|
|
|
|
|
%
|
47.11
|
50.07
|
2.82
|
100
|
|
|
|
|
Table 3: Malnutrition predictors in TB patients (n=1681).
Variables
|
Malnutrition
|
COR[1] [95 % CI]
|
AOR[2] [95% CI]
|
P-value
|
Underweight
|
Normal
|
Type of TB
|
Pulmonary TB
|
735
|
556
|
0.96 [0.76 - 1.21]
|
0.68[0.49-0.94]
|
0.02
|
Extra-pulmonary TB
|
226
|
164
|
Reference
|
Reference
|
|
Sex
|
Male
|
635
|
527
|
0.71[0.58 - 0.88]
|
0.39 [0.25-0.56]
|
<0.01
|
Female
|
326
|
193
|
Reference
|
Reference
|
|
Residence
|
Urban
|
493
|
218
|
2.43 [1.98 – 2.98]
|
3.84 [2.74-5.54]
|
<0.01
|
Rural
|
468
|
502
|
Reference
|
Reference
|
|
Educational status
|
Literate
|
756
|
544
|
1.19 [0.95 – 1.5]
|
0.72 [0.52-1.02]
|
0.06
|
Illiterate
|
205
|
176
|
Reference
|
Reference
|
|
Intestinal parasitic infection
|
Present
|
658
|
235
|
4.48 [3.64 – 5.51]
|
7 [5.2-9.95]
|
<0.01
|
Absent
|
303
|
485
|
Reference
|
Reference
|
|
Alcohol intake
|
Yes
|
430
|
277
|
1.29 [1.06 – 1.58]
|
1.52 [1.17-2.13]
|
<0.01
|
No
|
531
|
443
|
Reference
|
Reference
|
|
Anemia
|
Present
|
834
|
654
|
0.66 [0.48 – 0.91]
|
3.23 [1.89-5.51]
|
<0.01
|
Absent
|
127
|
66
|
|
|
|
Age
|
≥25
|
124
|
207
|
0.37 [0.29 – 0.47]
|
0.31 [0.21-0.46]
|
<0.01
|
<25
|
837
|
513
|
Reference
|
Reference
|
|
HIV infection
|
Positive
|
285
|
307
|
0.57 [0.46 – 0.70]
|
1.96 [1.47-2.7]
|
<0.01
|
Negative
|
676
|
413
|
Family size
|
>4
|
812
|
221
|
12.30 [9.65 – 15.69]
|
15.75 [11.58-21.42]
|
<0.01
|
≤4
|
149
|
499
|
Believe in avoiding a certain type of food
|
Yes
|
588
|
209
|
3.85 [3.13 – 4.74]
|
3.19 [2.37-4.31]
|
<0.01
|
No
|
373
|
511
|
[1] COR= crude odds ratio
[2] AOR= adjusted odds ratio
After adjusting for type of tuberculosis, sex, residence, educational status, intestinal parasitic infection, alcohol intake, age, HIV infection, family size, belief in avoiding a certain type of foods, income, smoking, and occupation; the following results were obtained: The odds of malnutrition among extra pulmonary TB patients were 47 % higher than pulmonary TB patients (AOR 0.68: [95% CI; 0.49-0.94]. In female TB patients, the odds of malnutrition were 2.56 higher than male. (AOR: 0.39 [95% CI; 0.25-0.56]). The odds of malnutrition among TB patients were 3.84 folds higher in the urban areas than the rural area (AOR 3.84 [95% CI: 2.74-5.54]). The odds of malnutrition were 7 folds higher among intestinal parasites positive TB patients than intestinal parasite negative TB patients (AOR 7: [95% CI: 5.2-9.95]). Problematic alcohol use increases the odds of malnutrition by 1.52 folds (AOR 1.52: [95% CI: 1.17-2.13]). Anemic TB patients had 3.23 folds higher risk of malnutrition than non-anemic TB patients (AOR 3.23: [95% CI; 1.89-5.51]). The odds of malnutrition was 3.23 higher in TB patients whose age was greater than 25 years (AOR 0.31 [95% CI; 0.21-0.46]). The odds of malnutrition were 1.96 folds higher among HIV positive TB patients than HIV negative TB patients (AOR 1.96: [95% CI; 1.47-2.7]). The odds of malnutrition were 15.75 folds higher among TB patients with high family size (AOR 15.75: [95% CI; 11.58-21.42]). Believe in avoiding certain types of food increase the odds of malnutrition by 3.19 folds (AOR 3.19: [95% CI: 2.37-4.31]). (Table 3).
Profile of TB free study participants
A total of 3364 TB free study participants were included giving for the response rate of 93.13 %. The mean age of the study participants was 28.3 years (SD ±14.03 years). Female constitute 65.5 % of the study participants, and 81.8% of the study participants were from the rural areas (Table 4).
Table 4: Profile of TB free study participants (n=3364)
SN
|
Population profile
|
Frequency
|
Percentage
|
Normal
|
Underweight
|
Frequency
|
Percentage
|
Frequency
|
Percentage
|
1.
|
Sex
|
Male
|
1162
|
34.5
|
851
|
25.3
|
331
|
9.2
|
Female
|
2202
|
65.5
|
1727
|
51.3
|
475
|
14.1
|
2.
|
Residence
|
Urban
|
611
|
18.2
|
451
|
13.4
|
160
|
4.8
|
Rural
|
2753
|
81.8
|
2127
|
63.2
|
626
|
18.6
|
3.
|
HIV status
|
Positive
|
31
|
0.9
|
15
|
0.4
|
16
|
0.5
|
Negative
|
3333
|
99.1
|
2563
|
76.2
|
770
|
22.9
|
4.
|
Income in birr
|
<1000
|
2558
|
76
|
2000
|
59.5
|
558
|
16.6
|
1000-2000
|
316
|
9.4
|
227
|
6.7
|
89
|
2.6
|
≥2001
|
490
|
14.56
|
351
|
10.43
|
139
|
4.13
|
5.
|
Occupation
|
Farmer
|
507
|
15.1
|
401
|
11.9
|
106
|
3.2
|
Others
|
2857
|
84.9
|
2177
|
64.7
|
680
|
20.2
|
6.
|
Smoking
|
Yes
|
140
|
4.16
|
119
|
3.5
|
21
|
0.6
|
No
|
3224
|
95.84
|
2459
|
73.1
|
765
|
22.7
|
7.
|
Family size
|
≤4
|
151
|
4.5
|
115
|
3.4
|
36
|
1.1
|
>4
|
3243
|
95.5
|
2463
|
73.2
|
750
|
22.3
|
8.
|
Marital status
|
Single
|
1474
|
43.8
|
1169
|
34.8
|
305
|
9.1
|
Married
|
1854
|
55.1
|
1379
|
41
|
475
|
14.1
|
Divorced
|
33
|
1
|
27
|
0.8
|
6
|
0.2
|
Widowed
|
3
|
0.1
|
3
|
0.1
|
0
|
0
|
9.
|
Anemia
|
Present
|
1742
|
51.8
|
1475
|
43.8
|
267
|
7.9
|
Absent
|
1642
|
48.2
|
1103
|
32.8
|
519
|
15.4
|
10.
|
Age in years
|
<25
|
2622
|
77.9
|
1984
|
59
|
638
|
19
|
≥25
|
742
|
22.1
|
594
|
17.7
|
148
|
4.4
|
11.
|
Intestinal parasitic infection
|
Ascaris Lumbricoides
|
530
|
15.8
|
331
|
9.8
|
199
|
5.9
|
Hookworm
|
401
|
11.9
|
268
|
8
|
133
|
4
|
Strongyloides stercolaris
|
99
|
2.9
|
74
|
2.2
|
25
|
0.7
|
Others
|
433
|
12.9
|
319
|
9.5
|
114
|
2.7
|
Not infected
|
1901
|
56.5
|
1586
|
47.1
|
315
|
9.4
|
Malnutrition in the TB free residents
The prevalence of malnutrition (underweight) among TB free residents was 23.37 % (95% CI: 21.93-24.80). The prevalence of anemia was 51.78 % (95 % CI: 50.09% - 53.47%). The predominant type of anemia was Normochromic Normocytic accounting for 63.32 %, followed by Hypochromic Microcytic anemia 32.72 %. (Table 5)
Table 5: The type of anemia among TB free residents (n=1742)
|
MCV
|
Total
|
Normal
|
Underweight
|
|
|
|
Frequency
|
Percentage
|
Frequency
|
Percentage
|
Normocytic
|
Microcytic
|
Macrocytic
|
MCHC
|
Normochromic
|
1103
|
11
|
6
|
1120
|
853
|
49
|
267
|
15.3
|
Hypochromic
|
2
|
570
|
4
|
576
|
576
|
33.1
|
0
|
0
|
Hyperchromic
|
2
|
12
|
32
|
46
|
46
|
2.6
|
0
|
0
|
Total
|
1107
|
293
|
42
|
1742
|
|
|
|
|
Table 6: Predictors of malnutrition among TB free residents (n=3364)
Variables
|
Malnutrition
|
COR [95 % CI]
|
AOR [95% CI]
|
P-value
|
Underweight
|
Normal
|
Smoking
|
Yes
|
21
|
119
|
0.57 [0.34 – 0.93]
|
0.64 [0.39-1.05]
|
0.076
|
No
|
765
|
2459
|
Sex
|
Male
|
311
|
851
|
1.33 [1.12 – 1.57]
|
2.5[1.72-3.63]
|
<0.01
|
Female
|
475
|
1727
|
Residence
|
Urban
|
160
|
451
|
1.21 [0.98 – 1.48 ]
|
0.89 [0.71 – 1.13]
|
0.34
|
Rural
|
626
|
2127
|
Income
|
<2000 birr
|
734
|
2442
|
0.79 [0.56 – 1.11]
|
1.434 [1.00 – 2.06]
|
0.06
|
≥2000 birr
|
52
|
136
|
Intestinal parasitic infection
|
Present
|
471
|
992
|
2.39 [2.02 – 2.82]
|
3.07 [2.38 – 3.96]
|
<0.01
|
Absent
|
315
|
1586
|
Alcohol intake
|
Yes
|
251
|
878
|
0.91 [0.76 – 1.08 ]
|
1.07 [0.88 – 1.29]
|
0.53
|
No
|
535
|
1700
|
Anemia
|
Present
|
267
|
1475
|
0.38 [0.32 – 0.46]
|
7.82 [5.74 – 10.63]
|
<0.01
|
Absent
|
519
|
1103
|
Age
|
≥25
|
148
|
594
|
0.77 [0.63 – 0.95]
|
0.73 [0.59 – 0.91]
|
<0.01
|
<25
|
638
|
1984
|
HIV infection
|
Positive
|
16
|
15
|
3.55 [1.66 – 7.61]
|
4.51 [2.13 – 9.53]
|
<0.01
|
Negative
|
770
|
2563
|
Family size
|
≤4
|
36
|
115
|
1.03 [0.69 – 1.53]
|
0.96 [0.63 – 1.43 ]
|
0.81
|
>4
|
750
|
2463
|
Believe in avoiding a certain type of food
|
Yes
|
447
|
1283
|
1.33 [1.13 – 1.57]
|
0.87 [0.73 – 1.05]
|
0.14
|
No
|
339
|
1295
|
After adjusting for sex, residence, educational status, intestinal parasitic infection, alcohol intake, age, HIV infection, family size, believe in avoiding a certain type of food, income, smoking, and occupation; the following results were obtained :
The odds of malnutrition were 2.5 folds higher in male than female (AOR 2.5: [95% CI; 1.72-3.63]). Intestinal parasitic infection increases the odds of malnutrition by 3 folds higher (AOR 3.07: [95% CI; 2.38 – 3.96]). The odds of malnutrition were 7.82 folds higher among anemic residents (AOR 7.82: [95% CI; 5.74 – 10.63]) than non-anemic residents. The odds of malnutrition among study participants whose age was ≥25 years was 27 % lower (AOR 0.73 [95% CI; 0.59 – 0.91]). HIV infection increases the odds of malnutrition by 4.51 folds than HIV free residents (AOR 4.5:1 [95% CI; 2.13 – 9.53]). (Table 6).