Abstract
Anaemia predicts delayed sputum conversion and mortality in tuberculosis (TB). We determined the prevalence and factors associated with anaemia among people with TB at the National Tuberculosis Treatment Centre in Uganda. People with bacteriologically confirmed TB were consecutively enrolled in a cross-sectional study between August 2017 and March 2018. Blood samples were tested for a full blood hemogram, HIV infection, and CD4+ and CD8+ T-cell counts. Anaemia was defined as a haemoglobin level of <13.0 grams per decilitre (g/dl) for males and <12.0 g/dl for females. Of 358 participants, 210 (58.7%, 95% confidence interval (CI) 53.4-63.8) had anaemia. Anaemia was associated with night sweats, a longer duration of fever, low body mass index (BMI), hyperthermia, high sputum bacillary loads, HIV co-infection, and low CD4 and CD8 counts at bivariate analysis. Factors associated with anaemia at multivariable analysis were low BMI (odds ratio (OR) 2.93, 95% CI 1.70-5.05, P < 0.001), low CD4:CD8 ratio (OR 2.54, 95% CI 1.07-6.04, P = 0.035) and microcytosis (OR 4.23, 95% CI 2.17-8.25, P < 0.001). Anaemia may be associated with the features of severe TB disease and should be considered in TB severity scores.
Highlights
Until 2020, tuberculosis (TB) was the leading cause of death from a single infectious agent and claimed the lives of at least 1.4 million individuals in 2019 [1]
Anaemia is associated with a four-fold risk for TB infection and a dose-dependent relationship between anaemia severity and TB risk has been demonstrated in a recent systematic review and meta-analysis [4]
We have recently shown that HIV-negative TB patients with anaemia were more likely to have low CD4 T-lymphocytes at the National Tuberculosis Treatment Center (NTTC) [12]
Summary
Until 2020, tuberculosis (TB) was the leading cause of death from a single infectious agent and claimed the lives of at least 1.4 million individuals in 2019 [1]. In sub-Saharan Africa, the treatment success rate in bacteriologically confirmed TB patients was recently reported to be only 76% against a global target of 90% [2]. The high prevalence of anaemia in TB is concerning because of its association with delayed sputum conversion [7], severe forms of TB (such as meningitis and disseminated disease) [8], TB-related mortality, and TB recurrence [9]. It is, imperative to screen for anaemia among people with TB and institute timely interventions
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