title: Tuberculosis risk factors among tuberculosis patients in Kampala, Uganda: implications for tuberculosis control.
abstract: BACKGROUND
  Slow decline in the incidence of tuberculosis (TB) has been observed in most high TB burden countries. Knowledge of the prevalence of different TB risk factors can help expand TB control strategies. However with the exception of Human Immunodeficiency Virus (HIV) the prevalence of the other TB risk factors are poorly studied in Uganda. We aimed to determine the prevalence of different TB risk factors and TB disease presentation among TB patients in Kampala Uganda.
  
  
  METHODS
  We assessed 365 adult TB patients and used descriptive statistics to summarize their socio-demographic, clinical, radiological, sputum mycobacteriology and TB risk factors (HIV, diabetes, TB contact, alcohol use, tobacco smoking, poverty and overcrowding) data.
  
  
  RESULTS
  A total of 158 (43.3%) patients were male and the median age was 29 (IQR 28-30). Majority of the patients (89.2%) had pulmonary TB, 86.9% were new and 13.2% were retreatment. Wasting (i.e. body mass index of <18.5 kg/m(2)) was found in 38.5% of the patients and 63% presented with cough. Constitutional symptoms (fever, anorexia, night sweats and weight loss) were reported by 32.1%. Most patients (78.6%) presented with non-cavity lung parenchyma disease (infiltrates, nodules, masses) but 35.2% had cavity disease. Pleural disease was detected in 19.3% of patients. Positive smear microscopy and culture (irrespective of month of treatment) was found in 52.7% and 36.5% of patients respectively. Any drug resistance was detected in 21.1% of patients while multidrug resistance (MDR) TB defined as resistance to rifampicin and isoniazid was detected in 6.3% of patients. All MDR patients were new patients. The prevalence of TB risk factors were as follows: HIV 41.4%, diabetes 5.4%, close contact 11.5%, family history 17.5%, smoking 26.37%, poverty 39.5%, overcrowding 57.3% and alcohol use 50.7%. Overcrowding increased smear positive rate, prevalence ratio 1.22, p = 0.09 but all the other studied risk factors did not affect clinical, radiological and mycobacteriological study patient characteristics.
  
  
  CONCLUSIONS
  Among TB patients in Kampala, Uganda, there is high prevalence of the known TB risk factors. Targeting reducing their prevalence may lead to better TB control in the country. Tuberculosis, risk factors, Uganda.
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. brucekirenga@yahoo.co.uk.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Kirenga
authors.affiliation: Department of Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. willyssengooba@gmail.com.|Department of Global Health and Amsterdam Institute of Global Health and Development, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100, DE, Amsterdam, Netherlands. willyssengooba@gmail.com.
authors.forename: Willy
authors.initials: W
authors.lastname: Ssengooba
authors.affiliation: National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda. cathiemagezi@yahoo.com.
authors.forename: Catherine
authors.initials: C
authors.lastname: Muwonge
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. lydikiyingi@yahoo.com.
authors.forename: Lydia
authors.initials: L
authors.lastname: Nakiyingi
authors.affiliation: National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda. stephenkyaligonza@yahoo.com.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kyaligonza
authors.affiliation: National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda. drsamuelkasozi@gmail.com.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kasozi
authors.affiliation: National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda. rfmugabe@gmail.com.
authors.forename: Frank
authors.initials: F
authors.lastname: Mugabe
authors.affiliation: Department of Pulmonary Diseases, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. m.boeree@ulc.um.cn.nl.
authors.forename: Martin
authors.initials: M
authors.lastname: Boeree
authors.affiliation: Department of Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. moses.joloba@case.edu.
authors.forename: Moses
authors.initials: M
authors.lastname: Joloba
authors.affiliation: National Tuberculosis treatment unit, Mulago Hospital, Kampala, Uganda. A_okwera@mucwru.or.ug.
authors.forename: Alphonse
authors.initials: A
authors.lastname: Okwera
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011322:Primary Prevention / Q000458:organization & administration*; D019233:Retreatment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents