Tuberculosis prevalence and associated factors among persons with diabetes mellitus after intensified case finding in three West African countries


Background: To determine the prevalence of tuberculosis (TB) and associated factors in persons with diabetes mellitus (DM) in Benin, Guinea and Senegal.
Methods: A cross-sectional study was conducted in the largest DM center in each country. Participants systematically underwent clinical screening and chest radiography. Participants who were symptomatic or with abnormal radiography underwent bacteriological investigations (sputum smear, Xpert MTB/RIF and culture) on sputum. Participants with no TB at enrolment were re-examined for TB six months later. Logistic regression was performed to identify factors associated with TB.
Results: There were 5870 DM patients: 1881 (32.0%) in Benin, 1912 (32.6%) in Guinea and 2077 (35.4%) in Senegal. Of these, 114 had bacteriologically-confirmed TB, giving a pooled prevalence of 1.9% (95%CI=1.6-2.3). TB prevalence was 0.5% (95%CI=0.3-1.0), 2.4% (95%CI=1.8-3.2) and 2.8% (95%CI=2.2-3.6), respectively, in Benin, Guinea and Senegal. Factors associated with an increased odds of TB diagnosis were a usual residence in Guinea (aOR=2.62;95%CI=1.19-5.77; p=0.016) or in Senegal (aOR=3.73;95%CI=1.85-7.51; p<0.001), the age group of 35-49 years (aOR=2.30;95%CI=1.11-4.79; p=0.025), underweight (aOR=7.34;95%CI=4.65-11.57; p<0.001) and close contact with a TB case (aOR=2.27;95%CI=1.37-3.76; p=0.002). Obesity was associated with lower odds of TB (aOR=0.20; 95%CI=0.06-0.65; p=0.008).
Conclusion: TB is prevalent among DM patients in Benin, Guinea and Senegal and higher than among the general population. The findings support the need for intensified case finding in DM patients in order to ensure systematic early detection of TB during the routine consultation process.



PlumX Metrics


Download data is not yet available.

Author Biography

Corinne Merle, Tropical Disease Research Special Programme, World Health Organization, Geneva

London School of Hygiene and Tropical Medicine, LSHTM, London, UK


World Health Organization. Global tuberculosis report 2020. Geneva: World Health Organization; 2020.

Uplekar M, Weil D, Lonnroth K, Jaramillo E, Lienhardt C, Dias HM, et al. WHO’s new end TB strategy. Lancet 2015;385:1799–801. DOI:

Martinez N, Kornfeld H. Tuberculosis and diabetes: From bench to bedside and back. Int J Tuberc Lung Dis 2019;23:669–77. DOI:

Martinez N, Kornfeld H. Diabetes and immunity to tuberculosis. Eur J Immunol 2014;44:617–26. DOI:

International Diabetes Foundation. IDF diabetes atlas, 4th ed. International Diabetes Foundation, Brussels.

Lin Y, Harries AD, Kumar AMV, Critchley JA, van Crevel R, Owiti P, et al. Tackling diabetes mellitus and tuberculosis: a new Union guide on the management of diabetes-tuberculosis. Int J Tuberc Lung Dis 2019;23:771–2. DOI:

Odone A, Houben RMGJ, White RG, Lönnroth K. The effect of diabetes and undernutrition trends on reaching 2035 global tuberculosis targets. Lancet Diabetes Endocrinol 2014;2:754–64. DOI:

Amberbir A. The challenge of worldwide tuberculosis control: and then came diabetes. Lancet Glob Health 2019;7:e390–1. DOI:

Workneh MH, Bjune GA, Yimer SA. Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: A systematic review. PLoS One 2017;12:1-25. DOI:

World Health Organization. Diabetes country profile. 2016. Available from:

World Health Organization. Tuberculosis country profiles. 2019. Available from:

World Health Organization. Systematic screening for active tuberculosis. 2015. Available from:

World Health Organization. TB diagnostics and laboratory services, information note. Available from:

World Health Organization. Recommendations for investigating contacts of persons with infectious tuberculosis in low- and middle-income countries. Available from:

Nachiappan AC, Rahbar K, Shi X, Guy ES, Mortani Barbosa EJ, Shroff GS, et al. Pulmonary tuberculosis: Role of radiology in diagnosis and management. Radiographics 2017;37:52-72. DOI:

Wagnew F, Eshetie S, Alebel A, Dessie G, Tesema C, Abajobir AA. Meta-analysis of the prevalence of tuberculosis in diabetic patients and its association with cigarette smoking in African and Asian countries. BMC Res Notes 2018;11:1-7. DOI:

Restrepo BI, Fisher-Hoch SP, Pino PA, Salinas A, Rahbar MH, Mora F, et al. Tuberculosis in poorly controlled type 2 diabetes: Altered cytokine expression in peripheral white blood cells. Clin Infect Dis 2008;47:634-41. DOI:

Skowroński M, Zozulińska-Ziólkiewicz D, Barinow-Wojewódzki A. Tuberculosis and diabetes mellitus - An underappreciated association. Arch Med Sci 2014;10:1019-27. DOI:

Harries AD, Kumar AMV, Satyanarayana S, Lin Y, Zachariah R, Lönnroth K, et al. Diabetes mellitus and tuberculosis: Programmatic management issues. Int J Tuberc Lung Dis 2015;19:879-86. DOI:

Badawi A, Gregg B, Vasileva D. Systematic analysis for the relationship between obesity and tuberculosis. Public Health 2020;186:246-56. DOI:

Lönnroth K, Williams BG, Cegielski P, Dye C. A consistent log-linear relationship between tuberculosis incidence and body mass index. Int J Epidemiol 2010;39:149-55. DOI:

Lin HH, Wu CY, Wang CH, Fu H, Lönnroth K, Chang YC, et al. Association of obesity, diabetes, and risk of tuberculosis: Two population-based cohorts. Clin Infect Dis 2018;66:699-705. DOI:

Lee K, Eckhardt J, Holden C. Tobacco industry globalization and global health governance: Towards an interdisciplinary research agenda. Palgrave Commun 2016;2:16037. DOI:

Original Research Articles
Supporting Agencies
Expertise France, Ministry of Foreign Affairs of France (Grant N°14SANIN210)
Tuberculosis, diabetes mellitus, disease burden, risk factors, West Africa
  • Abstract views: 2148

  • PDF: 62
  • HTML: 0
How to Cite
Wachinou, A. P., Ade, S., Ndour Mbaye, M., Bah, B., Balde, N., Gninkoun, J., Bekou, W., Sarr, M., Bah Sow, O., Affolabi, D., & Merle, C. (2021). Tuberculosis prevalence and associated factors among persons with diabetes mellitus after intensified case finding in three West African countries. Multidisciplinary Respiratory Medicine, 16.