IJBPAS, January, 2020, 9(1): 2598-2616 ISSN: 2277–4998 FREQUENCY AND RISK FACTORS OF TUBERCULOSIS AT A TERTIARY CARE HOSPITAL IN KHYBER PAKHTUNKHWA, PAKISTAN: A RETROSPECTIVE STUDY MUGHUL A1, ARIF S2, BASHIR S2, BASHIR A3, JAN A4, AZIZ N5, KHAN SFA6, SHAH ZU7, JAVAID A8 AND ULLAH I8, 9* 1Institute of Biological sciences, Sarhad university of Science and Information technology, Pakistan 2Department of Pathology, Gomal Medical College, Medical Teaching Institute, Dera Ismail Khan, Pakistan 3Woman Medical Officer, Basic Health Unit Malana, Dera Ismail Khan, Health Department, Pakistan 4Department of Pathology, District Headquarter Hospital, Medical Teaching Institute, Dera Ismail Khan, Pakistan 5Department of Pharmacology, Gomal Medical College, Medical Teaching Institute, Dera Ismail Khan, Pakistan 6Department of Zoology, University of Chitral, Pakistan 7Department of Pharmacy, Institute of Integrative Biosciences, CECOS University Peshawar, Pakistan 8Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital, Peshawar, Pakistan 9TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan *Corresponding Authors: Dr Irfan Ullah: Email: [email protected] Received 30thJuly 2019; Revised 28th Aug. 2019; Accepted 28th Sept. 2019; Available online 1st Jan. 2020 https://doi.org/10.31032/IJBPAS/2020/9.1.4928 ABSTRACT Background: Tuberculosis (TB) has been one of the biggest health problems across the world in human history. Pakistan is at 5th amongst the 22 high TB burden countries in the world. 2598 IJBPAS, January, 2020, 9(1) Ullah I et al Research Article Objectives of the current study were to assess the frequency of TB in different districts of KP and to investigate different risk factors and the association between different risk factors and TB in KP, Pakistan Material and Method: This study was conducted for a period of one year at Programmatic Management of Drug Resistant TB (PMDT) unit at tertiary care hospital, Lady Reading Hospital (LRH) Peshawar Pakistan. All the suspected cases were analyzed by LED-FM microscopy and Xpert MTB/RIF assay. The risk factors selected for investigation were demographic characteristics, socio economic, behavioral factors and clinical manifestations. Results: Out of 1691 suspected TB cases; MTB was detected in 1015 (60%) cases. Out of MTB, 137(13.5%) were drug resistant. Females with productive age (<44 years) were found infected more than males. Among diabetes, arthritis and hepatitis which were analyzed as comorbidities with TB diabetes was found to be present in 9.3% of the cases of TB, followed by arthritis and hepatitis which was present simultaneously with TB in 3% and 9% of the cases. The most obvious clinical manifestation of TB was found to be productive cough which was present in 92% of the cases. Weight loss was recorded in 62.5% cases, while hemoptysis was reported by 58.1% TB patients. Conclusion: The results of logistic regression showed that visit to high burden countries, age and active smoking were positively associated with the burden of this disease. Keywords: Tuberculosis, risk factors, Xpert MTB/RIF assay, Khyber Pakhtunkhwa INTRODUCTION Tuberculosis (TB) considers as the largest some of the co-morbid conditions is the public health mediation, which affects the reasons for development of TB. Proper world at different levels ranges from low diagnosis and treatment are necessary to frequency to an epidemic. According to the control the disease and decrease its report by the Center for Disease Control and transmission within communities. Limited Prevention (CDC), one third of the world's access to health services and lack of population is infected with TB that claims awareness on part of the society about this almost 5,000 lives daily and 40,000 lives per scourge and its risk factors are also reasons week (1). Increase in world population, for rise in TB. Familiarity with risk factors inadequate treatment resources, and lower related to disease transmission can be used to socioeconomic status of the population and decrease the infection rate. TB generally 2599 IJBPAS, January, 2020, 9(1) Ullah I et al Research Article target the lowest socioeconomic class that statistical association established between commonly faces problems such as various risk factors and TB in different areas malnutrition, unsafe cooking practices, also provides information that serves to illiteracy and overcrowding (2). The reduce the potential for the spread of TB in morbidity of diseases such as diabetes, HIV the province. and hepatitis worsens TB. A threefold higher MATERIALS AND METHODS recurrence of TB was found in diabetic Study Design and setting patients (3). Migrants and refugees from We conducted a cross-sectional study during countries with high incidence are also 2016-2017 at Department of Pulmonology, responsible for the disease. To a certain Lady Reading Hospital (LRH) Peshawar. It is extent, these groups can disseminate diseases located in the center of Peshawar city and in the general population (4). Pakistan is the comprises of districts Peshawar, Nowshehra sixth largest state in the world with high and Charsadda. It also provides tertiary care population growth rate. This country also has facilities throughout the province high burden of communicable diseases and Participant and Data Collection has to improve its health care delivery system Through questionnaire method we obtained specially to combat infectious diseases. TB the primary data by simple random sampling. remains a significant killer in Pakistan that Questionnaire method was valid, unbiased has infected millions of people and ranks and low cost. A structured questionnaire was fifth among the 22 high-TB burden countries developed in English language and translated (5). verbally in Urdu and Pashto to the patients to This study aims at evaluation of the remove ambiguity in the translation. prevalence of TB in different divisions of Disease detection Methods Khyber Pakhtunkhwa. Moreover, this also Two distinct procedures were used for our will establish statistical association between examination and to analyze the disease. the prevalence of infection and different risk WHO has recommended different types of factors. Beside the establishment of samples for pulmonary (sputum, bronchial predictors of a high TB this study also lavage and pleural fluid) and extra provided the opportunity to increase the pulmonary TB (lymph node biopsy, ascetic information on the prioritization of the risk fluid, cerebrospinal fluid, pericardial fluid, factors in vulnerable populations. The urine and pus) for detection purposes. 2600 IJBPAS, January, 2020, 9(1) Ullah I et al Research Article Smear Preparation and Microscopy container and manually stirred for a period of For the quantification and observation of 15 minutes. It was transferred carefully to a acid-fast bacilli (AFB) direct sputum smear single-use cartridge avoiding the pipetting of microscopy of the samples were performed. solid materials and the formation of bubbles. Samples of patients suspected of TB were A special cartridge containing all the taken in 5 ml of sterile plastic bottles reagents necessary for the lysis of bacterial followed by processes like cells, the extraction of nucleic acids, the decontamination, specimen concentration, amplification and the detection of amplicons slide preparation and Fluorochrome were used. The data obtained from Xpert staining with “auramine O”. Direct smears MTB/RIF assay confirmed the presence or were prepared in duplicate for staining with absence of MTB, as well as Drug resistance Auramin O. The smears were flooded with and indeterminate cases. “Auramin O” for 10 minutes, distained Data analysis with acid alcohol for 2 minutes and then All the analyses were done using the counterstained with potassium software package Statistical Package for the permanganate for one minute. With Social Sciences (SPSS) version 22. All the “Auramine O” staining, mycobacteria analyses were done using the software appear as bright yellow fluorescent rods on package SPSS version 22. Descriptive a dark background. The smears stained statistics was generated to understand the with “Auramin O” were analyzed on the distribution of scores of study variables and same day. Quantification and observation the underlying characteristics of the raw data, of acid-fast bacilli (AFB) was performed so that a platform for inferential statistics according to guidelines by WHO (1). The may be obtained (6). The Chi-Square test presence or absence of AFB was reported was used to evaluate the statistical significant using WHO guide. association between the factors and the Xpert MTB/RIF assay Analysis prevalence of TB value of 0.05 and the Four cartridges Xpert MTB/RIF assay with confidence interval (CI) were used to capacity to run four tests at once was used to evaluate the statistical significance of the detect the disease. A volume of reagent association between independent and buffer (sodium hydroxide and isopropanol- dependent variables. All the variables that containing sample) was added to the sample 2601 IJBPAS, January, 2020, 9(1) Ullah I et al Research Article were analyzed at the bivariate level were decrease in the chance of TB (OR = 0.822, entered into the multivariate analysis. 95% CI [0.676-0.999], p = 0.049). There was RESULTS no significant association between TB and Study population education (OR =7.80, 95% CI [0.564-1.077], A total of 1691 respondents included, p = 0.130). Marital status and the disease comprising