Berhe Gebretsadik, Enquselassie Fikre, Aseffa Abraham
Ethiop Med J. 2013 Oct;51(4):227-37.
Understanding the role of various determinants of tuberculosis (TB) is particularly important in countries like Ethiopia where TB is endemic and the resources available to public health intervention are limited However, little information is available on risk factors of TB to be able to effectively and efficiently control TB.
To identify and determine the potential host and environmental-related risk factors for development of active pulmonary tuberculosis (PTB) in the Tigray region of Ethiopia.
A matched case-control study was conducted from April-August 2011. Cases were defined as all newly diagnosed of PTB patients aged 15 years and above, who were registered by directly observed treatment short-course (DOTS) program health centers found in the randomly selected 16 districts in the region. Controls were age matched with no previous history of TB and chronic cough. For each case, two controls were recruited. Trained nurses collected data using structured and pre-tested questionnaire. Predictors of caseness were identified using conditional logistic regression method. Odds ratio were calculated with 95% confidence intervals to assess the strength of association.
Data was collected from 463 cases and 860 controls. The mean age of the cases and controls were 37 +/- 14.9 and 39 +/- 14.5 years, respectively. In the multivariable analysis significant risk factors for active PTB were illiteracy (OR = 1.90, 95% CI: 1.24, 2.93), household food shortage (OR = 2.38, 95% CI: 1.52, 3.73), HIV seropositivity (OR = 2.7, 95% CI: 1.42, 5.13), and past alcohol consumption (OR = 2.44, 95% CI: 1.08, 5.50). Marriage (OR = 95% CI: 0.37, 0.89) was identified as protective factor. Consumption of raw milk, history of imprisonment, having a separate kitchen, history of asthma and history of TB contact were significant risk factors on crude analysis but their significance was not maintained in multivariable analysis.
Our study results indicated that household food shortage, HIV sero-positivity, illiteracy, being married, smoking and alcohol consumption before six months have a substantially increased risk of developing tuberculosis, independent of other risk factors in adults in the Tigray region of Ethiopia. Hence, prevention and control efforts must target on this identified factors toward facilitating and effective and efficient TB control program in the study area.
在结核病（TB）呈地方性流行且公共卫生干预资源有限的国家，如埃塞俄比亚，了解结核病各种决定因素的作用尤为重要。然而，关于结核病风险因素的信息很少，难以有效且高效地控制结核病。
确定并判定埃塞俄比亚提格雷地区活动性肺结核（PTB）发生的潜在宿主及环境相关风险因素。
2011年4月至8月进行了一项配对病例对照研究。病例定义为所有15岁及以上新诊断的PTB患者，这些患者由该地区随机选择的16个区的直接观察短程治疗（DOTS）项目卫生中心登记。对照与病例年龄匹配，且既往无结核病和慢性咳嗽病史。每个病例招募两名对照。经过培训的护士使用结构化且经过预测试的问卷收集数据。使用条件逻辑回归方法确定病例的预测因素。计算比值比及95%置信区间以评估关联强度。
收集了463例病例和860名对照的数据。病例组和对照组的平均年龄分别为37±14.9岁和39±14.5岁。在多变量分析中，活动性PTB的显著风险因素为文盲（比值比=1.90，95%置信区间：1.24，2.93）、家庭食物短缺（比值比=2.38，95%置信区间：1.52，3.73）、HIV血清阳性（比值比=2.7，95%置信区间：1.42，5.13）以及既往饮酒（比值比=2.44，95%置信区间：1.08，5.50）。婚姻（比值比=95%置信区间：0.37，0.89）被确定为保护因素。生牛奶消费、监禁史、有独立厨房、哮喘病史以及结核病接触史在粗分析中是显著风险因素，但在多变量分析中其显著性未保留。
我们的研究结果表明，在埃塞俄比亚提格雷地区的成年人中，家庭食物短缺、HIV血清阳性、文盲、已婚、吸烟以及六个月前饮酒会大幅增加患结核病的风险，独立于其他风险因素。因此，预防和控制措施必须针对这些已确定的因素，以促进研究地区有效且高效的结核病控制项目。
