2017 Theses Doctoral

Understanding the relationship between Diabetes and Tuberculosis in Kazakhstan: Implications for integrated care and management

Aifah, Angela

The global increase in diabetes prevalence undermines public health efforts to eliminate TB globally by increasing TB morbidity and mortality. Emerging research suggests that diabetes has been found to increase likelihood of acquiring TB. However, there remains limited research on the multi-level risk and protective factors that are associated with these co-occurring problems and the long-term TB treatment outcomes for individuals who have both TB and diabetes. Using a matched case control study of 1600 participants in four regions of Kazakhstan, the findings from this dissertation show diabetes prevalence to be higher among those with TB than individuals without TB, at 7% and less than 1%, respectively. Multivariate logistic regressions noted that diabetes was roughly associated with nine times the odds of having both diabetes and TB (OR 8.6; 99% CI 4.13-17.85). Multilevel risk and protective factors significantly associated with both diseases included older age (45 years old and above); being obese (OR 8.19; P-value 0.015); having been to the doctor in the past 12 months (OR 4.80; P-value 0.006); urban residence (OR 3.34; P-value 0.021) and being born in a country other than Kazakhstan or Russia (OR 4.39; P-value 0.032). More importantly, the findings show that diabetes is not associated with unsuccessful TB treatment outcome as other studies have found. In general, the results of the current study point to the need to conduct robust, longitudinal studies that focus on the overlapping risk and protective factors associated with both diseases in order to better understand whether these risk factors are specific to particular settings or generalizable to all settings with high TB burdens.