People living with diabetes mellitus (DM) have higher chances of getting infected with Mycobacterium tuberculosis. When infected, they progress faster to more advanced disease stage. Also, treatment outcomes are worse in people with DM. Recent estimates suggest that nearly one in ten adults have DM worldwide. In Ethiopia, over 5 million adults are estimated to have abnormal blood sugar levels, and only a quarter of those with DM know their status.
To address this challenge, KNCV supported the TB program in Addis Ababa, Ethiopia, to set up a routine testing system both for TB and DM. Our support included training health workers, providing diagnostic test supplies, monitoring the progress, and evaluating the outcomes. The project was funded by the Dr. C. de Langen Stichting voor Mondiale Tuberculosebestrijding.

Mr. Zenebe, a 43-year driver and married with two children both below 15-year old, was diagnosed with TB in July 2020 and started his TB treatment at Bole 17 health center in Addis Ababa. This was his second episode of TB disease. During this round of treatment, he developed a burning sensation in his hands and feet besides being easily fatigued. These symptoms can be confused with side effects of anti-TB drugs. His treating physician Dr Bitania, who recently completed a TB/diabetes training course organized by KNCV, tested and confirmed his diagnosis of diabetes and put him on treatment. Mr Zenebe is now cured of his TB disease, is relieved of symptoms of diabetes complications, and his blood sugar is controlled. He later recalled that his father had diabetes too.

The above story highlights the added value of the integrated TB/diabetes screening project in improving TB and diabetes care. The aim of this project was to demonstrate feasibility of an integrated TB screening approach in an urban setting in Ethiopia.

Of 2381 TB patients tested, 197 (8.2%) had DM, and a half of these were unaware of their status. The proportion detected is 2.5 times higher than the prevalence estimate in the general population. This suggests the importance of routine DM screening among TB patients.

Of 7,394 DM patients screened, 28 were confirmed to have TB. This is nearly three-times higher than the expected prevalence estimate in the general population. Twenty of these were newly detected while eight were already on treated. Of the twenty newly diagnosed, eighteen were detected by chest X-ray, which shows the importance of routine chest X-ray screening in high burden settings.

Please click here for a link the most recent scientific publication on this project.

KNCV has been fighting TB since its establishment in 1903. Over the past 120 years, the organization has acquired indispensable knowledge and experience in the field of effective TB prevention and care, resulting in pre-elimination in the Netherlands and significant contributions to global evidence generation, policy development and TB program implementation worldwide.

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