Research Article: Integrating TB and non-communicable diseases services: Pilot experience of screening for diabetes and hypertension in patients with Tuberculosis in Luanda, Angola

Date Published: July 5, 2019

Publisher: Public Library of Science

Author(s): Giulia Segafredo, Anil Kapur, Claudia Robbiati, Nsuka Joseph, Joseth Rita de Sousa, Giovanni Putoto, Fabio Manenti, Andrea Atzori, Ugo Fedeli, Kahabi Ganka Isangula.


In the face of the rising burden of non-communicable diseases like diabetes mellitus (DM) and hypertension in sub-Saharan Africa, where infectious diseases like Tuberculosis (TB) are still endemic, the double burden of communicable and non-communicable diseases appears to be increasing rapidly. However, the size of the problem and what is the proper health system approach to deal with the double burden is still unclear. The aim of this project was to estimate the double burden of DM hypertension and TB and to pilot the integration of the screening for DM and hypertension in the TB national programs in six TB centers in Luanda, Angola.

All newly diagnosed pulmonary TB (PTB) patients accessing six directly observed treatment (DOT) centers in Luanda were screened for diabetes and hypertension. TB diagnosis was made clinically and/or with sputum microscopy DM diagnosis was made through estimation of either fasting plasma glucose (FPG) (considered positive if ≥ 7∙0mmol/l) or random plasma glucose (considered positive if ≥ 11∙1mmol/l). Uncontrolled hypertension was defined as systolic blood pressure (SBP) of ≥ 140 mm of Hg and/or diastolic blood pressure (DBP) of ≥ 90 mm of Hg, irrespective of use of antihypertensive drug.

Between January 2015 and December 2016, a total of 7,205 newly diagnosed patients with PTB were included in the analysis; 3,598 (49∙9%) were males and 3,607 females. Among 7,205 PTB patients enrolled, blood pressure was measured in 6,954 and 1,352 (19∙4%) were found to have uncontrolled hypertension, more frequently in females (23%) compared to males (16%). In multivariate logistic regression analysis uncontrolled hypertension was associated with increasing age and BMI and ethnic group. The crude prevalence of DM among TB patients was close to 6%, slightly higher in males (6∙3%) compared to females (5∙7%). Age adjusted prevalence was 8%. Impaired fasting glucose (>6∙1 to <7∙0 mmol/L) was detected in 414 patients (7%). In multivariate logistic regression analysis DM prevalence was higher in males and increased with increasing age and BMI. TB patients have a considerable hypertension and diabetes co-morbidity. It is possible to screen for these conditions within the DOTs centres. Integration of health services for both communicable and non-communicable diseases is desirable and recommended.

Partial Text

Despite substantial progress in the last two decades, Tuberculosis (TB) remains a considerable global public health concern, particularly among the poor and vulnerable populations [1]. However, even if low and middle-income countries still struggle to gain control over communicable diseases, they are being confronted with a new health-challenge. Non-communicable diseases (NCDs) are now the leading global cause of death and are responsible for 70% of deaths worldwide and approximately 80% of all NCD deaths in 2008 occurred in low and middle-income countries also prematurely. [2]

Between January 2015 and December 2016, a total of 7,205 newly diagnosed TB patients were included in the analysis, of which, 3,598 (49,9%) were males and 3,607 females.

The aim of the project was to explore the feasibility of integrating screening activities for uncontrolled hypertension and diabetes mellitus within routine TB activities rolled out by the NTP and to better understand what is the burden of the two conditions among newly diagnosed TB patients in an urban population of Luanda, the capital of Angola.