Population attributable risk of tuberculosis vulnerabilities in Kerala, India

Abstract

Background: A robust disaggregated understanding of the determinants of tuberculosis (TB) in each local setting is essential for effective health system and policy action to control TB. Objectives: The objective of the study was to identify population attributable risk (PAR) for TB disease based on the locally available evidences for Kerala, India. Methods: Systematic review was done for risk factors of TB in the state. The second set of searches was done to understand the prevalence of the identified risk factors in general population in Kerala. With all available studies and reports, an expert group consensus was made to finalize state-specific prevalence of risk factors. Population attributable fractions were calculated for identified risk factors. Results: PAR for TB disease in Kerala obtained was 24% for undernutrition, 15% for diabetes, 15% for tobacco use, and 1% for HIV. Conclusion: Kerala state's PAR for TB was comparatively lower for HIV but higher for diabetes mellitus. Similar exercises for summarizing population risk factors need to happen at all states for making plans to effectively combat TB.

Tuberculosis epidemic in India – a systematic review

“…Undernutrition, which affects 6.90 million people globally, is on the rise, negatively impacts people's immune systems, and is a risk factor in TB, although it is described as an individual's intake of insufficient calories and nutrients to meet their need to maintain good health. 8,32,73,74 Several studies have found that adults aged 15-49 years with a low body mass index (BMI) (<18.50 kg/m 2 ) are more likely to develop TB, experience poor treatment outcomes, and have a higher risk of death. 9,28,31,37,38,41,73,74 Rural areas, scheduled castes and tribes, other socially and economically backward classes, states with higher levels of poverty, and migrant workers all have high rates of undernourishment, which increases their risk of developing TB.…”

“…1,2,[16][17][18][19][20][21][22] Co-morbidities that weaken the immune system and increase the risks of TB infection in people over a short period of time include undernutrition, diabetes, HIV, tobacco use, smoking, and alcohol consumption. 2,[21][22][23][24][25][26][27][28][29][30][31][32] M. tuberculosis also has a diverse pattern of region-specific prevalence and susceptibility, genetic mutation over time, space, and environment. 23,33,34 Nearly one in every two TB patients' household contacts has latent TB, and the severity of the infection is related to the age of the household contacts.…”

Individuals’ Vulnerability Based Active Surveillance for TB: Experiences from India

“…Common risk factors (vulnerabilities) for TB in Kerala were listed. The process undertaken for identifying TB risk factors and estimating their relative risks through a systematic literature review of locally available studies and programmatic data have been described elsewhere [7]. Weighted scores were assigned to the vulnerabilities based on the estimates of relative risk [7,8].…”

“…The process undertaken for identifying TB risk factors and estimating their relative risks through a systematic literature review of locally available studies and programmatic data have been described elsewhere [7]. Weighted scores were assigned to the vulnerabilities based on the estimates of relative risk [7,8]. The use of an expert group consensus has been widely accepted as a method for providing a basis for decision-making when there is limited evidence or when there are doubts about the applicability of evidence that has been generated from other populations.…”

“…An expert group was assembled, consisting of nine purposefully selected experts, including 2 program managers, 2 epidemiologists, 3 public health experts, and 2 clinicians, all of whom had worked for a TB program for more than 5 years. The expert group looked at the relative risks of each vulnerability factor [7], as well as the quality and strength of evidence in the local contexts, and discussed and finalized the final weighted scores for each vulnerability factor. The vulnerability factors considered (with their weighted scores in brackets) were as follows-household contact (5), healthcare worker (3), diabetes (3), tribal (3), mine/quarry worker (2), liver/kidney disease (2), bedridden/palliative care (2), past TB (3), coastal residence (2), chronic lung disease (2), smoking (3), harmful consumption of alcohol (pattern of use that is causing damage to physical or mental health) (2), slum dwelling (1), and migrant (2).…”