prevelence of depression in tuberculosis patients

MD thesis defence presented by Dr kehbila jules

1. MD THESIS DEFENCE
1

2. UNIVERSITY OF BUEA
FACULTY OF HEALTH SCIENCES
DEPRESSION IN ADULT PULMONARY
TUBERCULOSIS PATIENTS IN THE SOUTH
WEST REGION OF CAMEROON
 

By
 
KEHBILA JULES
SUPERVISOR CO-SUPERVISORS
 
Pr KUABAN CHRISTOPHER Dr VERLA VINCENT SIYSI
Dr NDE FON PETER
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3. OUTLINE
1.INTRODUCTION
2.RESEARCH OBJECTIVES
3.METHODOLOGY
4.RESULTS and DISCUSSION
5.CONCLUSION
6.RECOMMENDATIONS
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4. 1. INTRODUCTION
•The global incidence of tuberculosis in 2013, was 9
million with more than half (56%) in South-East Asia
and Western Pacific Regions.

•25 million were in the African Region, which also had
the highest rates of cases and deaths relative to
population [WHO TB report, 2014].
•In Cameroon the incidence of tuberculosis was 235
per 100000 people in 2014[World Bank, 2014]
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5. 1. INTRODUCTION
•According to Marina et al, Depression is a common
mental disorder that is characterized by loss of
interest or pleasure.
•Depression, has a lifetime prevalence of 10% (Wells
et al, 1988). Depression affects 350 million people
globally.
•Fourth most common cause of disease morbidity
and mortality world wide (Marcus et al, 2012).
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6. 1. INTRODUCTION
•TB incidence in Cameroon has decreased slowly
from 260 per 100000 to 235 per thousand from
2010 to 2015 and the prevalence is still high, this
can be due to high rate of poverty, HIV/AIDS,
increase rate of discontinuation of treatment
advent of MDR.
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7. 1. INTRODUCTION
•The prevalence of depression in TB patients vary from 39%
in Romania, 54-82% in India, 81% in South Africa, and 27-
45% in Nigeria. In Cameroon 30.9%.
•Depression has been identified as a co morbid condition in
TB and has been associated with antibiotic drug resistance,
high rates of community transmission and increased level
of morbidity and mortality.
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8. 1. INTRODUCTION
•Determining the prevalence and identified risk
factors of depression in tuberculosis patients if high,
will go a long way to enable planning for Screening,
Diagnosis and Treatment of depression in TB
patients.
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9. 2.RESEARCH OBJECTIVES
•To determine the prevalence of depression in
tuberculosis patients in the south west region of
Cameroon.
•To assess the risk factors of depression in
tuberculosis patients in the south west region of
Cameroon.
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10. 3. METHODOLOGY
•STUDY DESIGN AND PERIOD
•This was a hospital based cross-sectional
Observational study
•January to March 2015
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11. 3 STUDY SETTING
•The study was conducted in the South West Region,
Limbe Regional Hospital and District Hospital Kumba.
•These are the Main TB treatment and referral centers in
the region.
•Well organized, equipped for the diagnosis, Management
and follow up of TB patients.
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12. 3 SELECTION CRITERIA
•Inclusion criteria
•Patients diagnosed with PTB for at least 2 weeks.
•Patients older than 20 years
•Patients who give consent to the study
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13. 3 SELECTION CRITERIA
•EXCLUSION CRITERIA
•Patients with any underlying mental illness.
• Patients who do not understand French,
English or Pidgin English.
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14. 3 SAMPLE SIZE AND SAMPLING
•Sample size formula (Daniel, 1999)
N = PQ(Z)² = 254 Participants
d² P= 0.309 Balkissou et al[32]
•A minimum sample size of 254 patients was obtained.
•convenient sampling was applied till a sample of 265
patients was attained during the sampling period
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15. 3 STUDY PROCEDURE
.

Depression
Diagnosed
Administrative
authorization
DATA
ANALYSIS


Ethical
clearance


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16. RESULTS AND DISCUSSION
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17. 4.1 SOCIO- DEMOGRAPHIC CHARACTERISTICS
•Among the 265 patients recruited 129(48.7%)
were males and 136(51.3%) females.
•Their ages ranged from 21 to 66 years with mean
age 36.98 ±10.096 years. The modal age group
was 31-40, representing 38.5% of the study
population.
•A greater proportion of the population were single
139 (52%).
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18. 4.2 CLINICAL CHARACTERISTICS
•169 (63.8%) had BMI between 18.5 and 25.5 and
78(29.4%) were underweight.
•204 (77%) of the participants were sputum positive
and 61(23%) were sputum Negative.
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19. characteristicsFrequency percentage
treatment status
New Case
Retreatment Case
 
213
52
 
80.4
19.6
 
Treatment Phase
Intensive
Continuation
 
146
119
 
 
55.1
44.9
Method of treatment at
time of study
Hospitalized
Out Patient
 
106
159
 
40
60
Other Co-morbid
conditions
Yes
NO
 
100
165
 
 
37.7
62.3
Family history of mental
illness
Yes
NO
 
68
197
 
25.7
74.3
 
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20. 4.3 PREVALENCE OF DEPRESSION
•From the PHQ-9(Kroenke et al) depression classified
according to the scores into; none (0-4),
•mild (5-14) and
•moderate (15-27).
•(Basu et al[23], Issa et al[31]. Masumoto et al [28]). (see
page 66 and 67)
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21. 4.3 Prevalence of depression
•The overall prevalence of
depression in tuberculosis
patients was 61.13% (95% CI =
55.1-66.8), 36.60% mild and
24.53% moderate. The mean
score on the PHQ-9 was
10.92±2.03.
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22. 4.3Prevalence of depression
Author Year Location Sample sizeTool of
Diagnosis
Prevalence
This study2015 Cameroon
(SWR)
265 PHQ-9 61.13
Balkissou et
al
2012 Cameroon
Yaoundé
298 PHQ-9 30.9
Issa et al 2009 Ilorin, Nigeria65 PHQ-9 27.7
Peltzer et al2012 South Africa4900 K-10 81
Basu et al2012 Bengal
India
110 PHQ-9
62
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23. 4.5 Risk Factors of depression
Risk Factors This study Similar Contrast
Gender (Females)
P<.001
Adina at al
(p = .004),
Ugarte-Gil et al (p
=.045),
Masumoto et al
(p=.042)
Peltzer et al(p>.05),
Issa et al
p=.137.
Body Mass Index
BMI<18.5
(Underweight) P=.029
Masumoto et al
P<.001
Treatment StatusRetreatment P<.001Peltzer et al
P<0.05
Masumoto et al
P=0.14
Discontinuation of
treatment
P=.003 Not studied
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24. 4.5 Risk Factors of depression cont
Risk Factors This study Similar Contrast
Living alone P<.016 Not studied
Other Co-
morbidities
TB/HIV co-
infection
P<.001
Peltzer et al,
p<.001
Adem et al
P<.001
Family history of a
Mental Illness
.001 Davoodian et al
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25. STUDY LIMITATIONS
•Our study was conducted in two hospitals in the south
west region which may not be representative of the
general population.
•PHQ-9 can overestimate the prevalence of depression in
Tb patients due to the superimposition of the somatic
symptoms like cough leading to insomnia.
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26. STRENGHTS
•This is one of the pioneer researches on TB and depression
in Our country.
•The screening tool used in our study is a standard validated
tool.
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27. 27

28. 5 CONCLUSION
•Our overall findings show a high prevalence of
depression in Tuberculosis patients in the Limbe and
Kumba.
•Females(75%), underweight(70.5%), patients on
retreatment(84.6%), family history of a mental
disorder(77.9%), and TB/HIV co-infection(79%), were
associated with depression in TB patients.
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29. 6. RECOMMENDATIONS
•The Audience and general population should avoid the
stigma of rejection and isolation of Tb patients and
should provide social support and assist them in taking
their medications.
•The doctors in the LRH and DHK who see TB patients
should identify those with risk factors, screen and treat
for depression.
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30. 6. RECOMMENDATIONS
•The Ministry of Public Health and the National
tuberculosis programme should integrate Mental
Health Services in the daily care of TB patients.
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31. 6. RECOMMENDATIONS
•Initiate Courses to train health personnel on Mental
health care and counseling.
•To organize sensitization programmes to improve on
the awareness of tuberculosis.
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32. PROJECTIONS FOR FURTHER STUDIES
•To carry out more and larger research at the community
level, establish a National prevalence and to further
associated risk factors.
•Prospective studies and associations between drug
resistance and depression.
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33. ACKNOWLEDGMENT
•Prof Kuaban Christopher
• Dr Verla Vincent Siysi,
•Dr Nde Fon Peter
•The Entire staff of the FHS
•The Entire staff of the LRH and DHK
•My family and all present here
•Above all to God almighty.
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