The Effects of Cigarette Smoking and Alcohol Consumption on Patients With Pulmonary Tuberculosis (Other (Not Listed) Sample)

Effects of Smoking and Alcohol on Treatment Outcomes Among Pulmonary Tuberculosis Patients at a Health Facility in Nigeria
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Abstract
Tuberculosis is of high burden in the middle and low-income countries. Report by the World Health Organization shows that between 9 and 11 million people were infected globally in 2018. The fatalities from the infections were staggering as 1.3 million people without HIV/AIDS dies compared to 255000 people living with HIV/AIDS who died. Despite these figures, few studies have been done to establish the link between smoking and alcohol use and their effects on treatment outcomes. This study will therefore focus on the effect of smoking and alcohol use on the treatment outcomes among tuberculosis patients in the TB clinic in Lagos, Southwestern Nigeria. The study is a quantitative cross-sectional study with a sample size of 169 participants to be sampled conveniently. The subjects of the study will be people aged 18 years and above smoking cigarette or using alcohol and are on therapy for TB. The results will be analyzed and discussed and conclusions drawn in line with the study objectives.
Effects of Smoking and Alcohol on Treatment Outcomes Among Pulmonary Tuberculosis Patients at a Health Facility in Nigeria.
Introduction
Background
Tuberculosis, abbreviated as TB is a bacterial infection that affects virtually all organs of the human body except nails and hair. One major site for TB infection is the lungs where it is known as pulmonary tuberculosis. Pulmonary tuberculosis is caused by several bacterial organisms the major one being Mycobacterium tuberculosis, which is responsible for most infections. According to worldwide statistics released by the W.H.O. in 2018, between nine to eleven million people were infected in 2018 alone. The same data release by WHO showed an interesting association between TB and HIV positive and negative individuals. HIV negative individuals had more fatalities, about 1.2 million deaths as compared to 251000 deaths among the HIV positive individuals (World Health Organization, 2020). TB has surpassed HIV/AIDS in being the leading cause of death from a single infectious agent since the year 2007.
Nevertheless, alcohol and smoking have been two major issues of concern worldwide, especially when considering treatment outcomes in tuberculosis patients. Studies done in Asia reveal that smoking raises the mortality rate and severity of tuberculosis infection (Khan et al., 2020). Since the beginning of a focus on exposure prevention, the W.H.O has tried to establish the relationship between smoking and alcohol on effective treatment outcomes. While many studies link smoking with cancer and cardiovascular disease, there are only a few papers that have been written to support the link between smoking and treatment outcomes. The scenario is even worse when it is linked with alcohol as many studies have only focused on smoking leaving alcohol use a less explored area.
According to Khan et al. (2020), the components of cigarette smoke such as carbon monoxide, free radicals, acrolein and formaldehyde causes oxidative stress on the bronchial mucosa leading to the destruction of the first-line defences for Mycobacterium tuberculosis prevention. The mechanism by which TB affects treatment outcomes are also poorly understood, and there are only a few proposed mechanisms that include heavy alcohol use leads to increased chances of missing clinic visits and adherence to treatment. Mouse models fed on ethanol show higher burden of Mycobacterium tuberculosis and slow rate of granuloma formation and poor response to BCG vaccine as well (Myers et al., 2018). Alcohol is also responsible for reducing the activity of macrophages and bactericidal activity of the macrophages and other cellular immunity components that are responsible for walling off the infection. Another hypothesis regarding alcohol use is on its effect on pharmacokinetics and pharmacodynamics of the TB drugs. Bioavailability of these drugs affects treatment outcomes since alcohol is metabolized by the same enzymes in the liver responsible for the metabolism of anti TB drugs (Imtiaz et al., 2017). While these findings are seen on those patients who consistently take their medications, human studies must be done to properly establish these hypotheses.
As many of these studies are being done worldwide, only a few of them have been done in Nigeria. Nigeria is one of the 30 high burden countries in sub-Saharan Africa and is the second in Africa. Studies done before have focused on possible risk factors for poor TB treatment outcomes, in this study, however, the focus will be on alcohol and smoking effect in terms of adherence to treatment and desirable treatment outcomes.
Statement of the Problem
Since 2007, research has focused on establishing the link between risk factors and effects on TB treatment outcomes (Khan et al., 2020). However, the effect of alcohol and smoking on human subjects adherent to TB drugs has not been adequately explored. TB is also of high burden in Nigeria and it is against this background that conducting the study will therefore explore and establish the link between alcohol, smoking and how they influence treatment outcomes among patients with tuberculosis.
Justification of the Study
Since only a few studies have been done in Nigeria before, this research would help to establish the link between TB treatment and tobacco smoking, alcohol use among TB patients attending a clinic in Nigeria. This link will also establish baseline information on the effects of smoking and alcohol consumption on compliance with medication and treatment outcomes. The information on the topic of interest has been dealt with elsewhere to provide the foundation for this study. Unfortunately, the data available is scanty to substantiate an argument among Nigeria TB patients. This study is done in a bid to bridge the knowledge gap existing. The findings would therefore help improve the management of TB patients during the period of therapy.
Research Questions
Do smoking and drinking alcohol affect treatment outcomes among TB patients?
Main Objective
* To determine the effect of tobacco smoking and alcohol on adherence to treatment and desirable treatment outcomes among TB patients.
Specific Objectives
1.To determine the proportion of TB patients who take alcohol and smoke tobacco at the TB clinic.
2.To determine the adherence to treatment and treatment outcomes among tobacco smoking and alcohol drinking TB patients.
Review of Literature
Many studies concerning the effects of alcohol and smoking on TB treatment outcomes are majorly done in the low and middle-income countries. It is in such countries as Asia and sub-Saharan Africa where the prevalence of TB is high and therefore, establishing such links are important aspects of research on human subjects (Harries et al., 2018). World Health Organization published a study by Gegia et al. (2015), conducted in Tbilisi, Georgia. This study was a prospective cohort study examining the effect of smoking on treatment outcomes among TB patients. Findings were particularly interesting as per the topic of our study as smoking was found to be an independent risk factor for poor outcomes of treatment among tuberculosis patients. Patients who ceased smoking had improved outcomes and the authors, therefore, encourage smoking cessation programs as a means of reducing poor treatment outcomes. The gap in the study, however, is the effectiveness of such interventions in improving treatment outcomes.
A different study by Thomas et al. (2019) assessed the effect of alcohol use disorder and smoking on tuberculosis treatment outcomes. The study found out that past and current history of smoking combined with the misuse of alcohol multiplies the risk of undesirable TB treatment outcomes. This paper also looked at the combined effect of alcohol and smoking where the effect was greater among past smokers. The gap in this study, however, is the lack of innovative interventions to help address the co-morbidities.