{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:40:12Z","timestamp":1756662012325,"version":"3.44.0"},"reference-count":52,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Global Health PhD Support Programme at the University Medical Center, Utrecht, The Netherlands","award":["Not Applicable"],"award-info":[{"award-number":["Not Applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2024,12,20]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The increasing burden of diabetes mellitus in low- and middle-income countries negatively impacts tuberculosis control. To understand this dual burden in Eswatini, we describe the prevalence and predictors of elevated baseline blood glucose and unfavourable tuberculosis treatment outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a prospective cohort study at 11 health facilities in Eswatini and included adults \u226518 years commencing tuberculosis treatment. Blood glucose measurements were taken at baseline, months 2 and 5, and patients\u2019 sociodemographic and clinical data were extracted. We computed the prevalence of elevated blood glucose and used logistic regression to determine the predictors of elevated baseline blood glucose and unfavourable treatment outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 369 consecutively enrolled patients, the mean age was 38.4 (SD 12.9) years, and 202 (54.7%) were males. The prevalence of elevated baseline blood glucose was 8.0% (95% CI: 5.5, 11.3); 8.9% in males (95% CI: 5.6, 13.9); highest at \u226555 years (13.6%; 95%\u2009CI: 6.2, 27.3) and in patients with reactive HIV at 9.5% (95% CI: 6.5, 13.7). A family history of diabetes mellitus (adjusted OR (AOR) 2.80; 95% CI: 1.08, 7.32) and a reactive HIV status (AOR 4.62; 95% CI: 1.06, 20.11) significantly predicted elevated baseline blood glucose. Three-quarters (n=276, 75.4%) had a favourable tuberculosis treatment outcome; more males (n=59, 66%) had an unfavourable treatment outcome (p=0.020), the most common unfavourable outcome being death (n=34, 9.2%). Hypertension (AOR 4.84; 95%\u2009CI: 1.48, 15.7), unemployment (AOR 2.01; 95% CI: 1.08, 3.71) and high school education (AOR 0.32; 95% CI: 0.16, 0.64) were associated with unfavourable treatment outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our study shows the need to optimise care for patients receiving treatment for tuberculosis by integrating screening for and treatment of diabetes and hypertension, prioritising males, those aged \u226555 years and those with a reactive HIV status to limit unfavourable outcomes and death.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001407","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T02:50:39Z","timestamp":1737082239000},"page":"e001407","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Elevated blood glucose and unfavourable tuberculosis treatment outcomes in a low-income setting: findings from a prospective cohort study in Eswatini"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0594-3433","authenticated-orcid":false,"given":"Victor","family":"Williams","sequence":"first","affiliation":[{"name":"Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"},{"name":"National Tuberculosis Control Program, Manzini, Eswatini"},{"name":"Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alinda G","family":"Vos-Seda","sequence":"additional","affiliation":[{"name":"Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"},{"name":"Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne","family":"Calnan","sequence":"additional","affiliation":[{"name":"University Research Co LLC, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colani S","family":"Ngwenya","sequence":"additional","affiliation":[{"name":"Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samson","family":"Haumba","sequence":"additional","affiliation":[{"name":"Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini"},{"name":"Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindiwe","family":"Mdluli-Dlamini","sequence":"additional","affiliation":[{"name":"National Tuberculosis Control Program, Manzini, Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diederick E","family":"Grobbee","sequence":"additional","affiliation":[{"name":"Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kennedy","family":"Otwombe","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"},{"name":"Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerstin","family":"Klipstein-Grobusch","sequence":"additional","affiliation":[{"name":"Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"},{"name":"Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"},{"name":"Institute of Tropical Medicine, University of T\u00fcbingen, Tubingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"2025083110200782000_3.1.e001407.1","unstructured":"World Health Organisation . 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