Vitamin D Deficiency among Smear Positive Pulmonary Tuberculosis Patients and Their Tuberculosis Negative Household Contacts in Northwest Ethiopia: A Case-Control Study

Journal Article
  • Belay Tessema
  • Feleke Moges
  • Dereje Habte
  • Nebiyu Hiruy
  • Shewaye Yismaw
  • Kassahun Melkieneh
  • Yewulsew Kassie
  • Belaineh Girma
  • Muluken Melese
  • Pedro G. Suarez
Annals of Clinical Microbiology and Antimicrobials
2017; 16 (1): 36. DOI: 10.1186/s12941-017-0211-3.
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Background: Vitamin D is a fat-soluble vitamin that increases immunity against tuberculosis (TB), decreases the re-activation of latent TB and reduces the severity of active TB disease. Epidemiological studies on the prevalence of vitamin D deficiency, and its association with TB showed inconsistent results in different countries. This study aimed to determine the prevalence of vitamin D deficiency and its association with TB in Northwest Ethiopia.

Methods: A case–control study was conducted among smear positive pulmonary tuberculosis patients and their household contacts without symptoms suggestive of TB. Study participants were recruited at 11 TB diagnostic health facilities in North and South Gondar zones of Amhara region between May 2013 and April 2015. Morning spot sputum samples and 5 ml blood samples were collected prior to commencing TB treatment for the diagnosis of TB and serum vitamin D assay, respectively. The diagnosis of TB was performed using smear microscopy and GeneXpert. Serum vitamin D level was analyzed using VIDAS 25 OH Vitamin D Total testing kits (Biomerieux, Marcy I’Etoile, France) on mini VIDAS automated immunoassay platform. Vitamin D status was interpreted as deficient (<20 ng/ml), insufficient (20–29 ng/ml), sufficient (30–100 ng/ml) and potential toxicity (>100 ng/ml).

Results: Of the total study participants, 134 (46.2%) were vitamin D deficient, and only 56 (19.3%) had suficient vitamin D levels. A total of 59 (61.5%) TB patients and 75 (38.7%) non TB controls were vitamin D deficient. Results of multivariate logistic regression analyses showed a signifcantly higher vitamin D deficiency among tuberculosis cases (p < 0.001), females (p = 0.002), and urban residents (p < 0.001) than their respective comparison groups. Moreover, age groups of 35–44 (p = 0.001), 45–54 (p = 0.003) and ≥55 (p = 0.001) years had significantly higher vitamin D deficiency compared with age group <15 years.

Conclusions: Vitamin D deficiency is highly prevalent among TB patients and non TB controls in Ethiopia, where there is year round abundant sunshine. Study participants with tuberculosis, females, older age groups, and urban residents had signifcantly higher prevalence of vitamin D deficiency. These fndings warrant further studies to investigate the role of vitamin D supplementation in the prevention and treatment of tuberculosis in high TB burden countries like Ethiopia.