感染症と治療ジャーナル

抽象的な

Prevalence of Substance Dependence among Susceptible TB Patients in a Private Sector Hospital in Karachi, Pakistan

Sara Khan, Zainab Barry, Salman Khan, Ata-ur-Rehman and Naveed Ali Khan

Background: Pakistan ranks sixth amongst the twenty-two TB high-burden countries in the world, accounting for one of the major health problems in Pakistan. Substance abuse is the most commonly reported behavioral risk factor among TB patients.

Objective: The objective of this study was to find out substances TB patients use frequently.

Study design: Retrospective Analytical study.

Methodology: A retrospective review was performed to analyze substance dependence in TB patients at Indus Hospital. Data were collected from 1,234 newly enrolled adult patients counseled at baseline from February 2012 to February 2014. The patients were categorized as substance dependent if they were positive on three of the seven criteria within the same year as defined by Diagnostic Statistical Manual of Mental Disorder Text Revision (DSM IVTR). Tolerance, increased amount of substance and persistent desire or unsuccessful efforts to cut down or control substance use was observed in our patients.

Results: Out of the 1,234 TB patients 590 (48%) were males and 644 (52%) were females. Overall 20% (251/1,234) of patients reported taking different substances were categorized as substance dependent out of which 85% (214/251) were males while 15% (37/251) were females. Cigarette smoking (up to a pack/day) was the most common addiction among patients, higher in males 51% (105/214) compared to 4% (2/37) females. 10% (21/214) of males used Niswar (smokeless tobacco) compared to 4% (2/37) females. Ghutka was comparatively more common in females 24% (11/37) than males 9% (18/214). Chewable tobacco was used by 7% (14/214) males compared to 35% (16/37) females. 5% (11/214) males used pan compared to 2% (1/37) females. Alcohol and charas (hashish) were respectively used by 0.5% (1/214) males only. 21% (44/214) males were addicted to multiple substances compared to 11% (5/37) females. The Indus Hospital provided special counseling to these patients about adverse reactions of substance on TB treatment and general health to ensure treatment compliance.

Conclusion: TB and substance abuse programs need to work hand in hand since substance abuse is associated with negative treatment outcomes. Effective interventions need to be developed by TB programs to address the need of patients who indulge in substance abuse.