Social determinants of abdominal tuberculosis severity: An experience from a large tertiary care center

Abstract

Background and Objective: Abdominal tuberculosis is a concern in developing countries due to socioeconomic factors, influencing disease severity. This study at Jinnah Postgraduate Medical Centre (JPMC), Karachi, aimed to explore the link between social determinants like socioeconomic status, residence, co-morbidities, addiction patterns, and abdominal tuberculosis severity in patients.

Methodology: A descriptive cross-sectional study was conducted at the Department of Gastroenterology, JPMC, Karachi. Study duration was 16 months from September 26, 2024 to January 26, 2026. A total of 503 patients diagnosed with intestinal tuberculosis were included. Data on social determinants such as socioeconomic status, residence, addiction, HIV status, diabetes, and malnutrition were collected. Disease severity was categorized as mild, moderate or severe based on clinical and radiological, endoscopic assessment. Associations between social determinants and abdominal tuberculosis severity were analyzed using Chi-square tests with a significance level of p ≤ 0.05.

Results: The sample was nearly evenly split by gender and had a mean age of 47.7 years. Most participants came from urban areas and low to middle socio-economic backgrounds. Notably, 20.3% were HIV-positive, 4.2% had diabetes, and nearly one-third (32.7%) were malnourished. Addictive behaviors were common, with 27.8% chewing tobacco and 15% smoking. The severity of intestinal TB was classified as mild (39.9%), moderate (30.7%), or severe (29.4%), based on predefined criteria. While gender, socio-economic status, residence, and HIV status were not significantly associated with disease severity, diabetes (p = 0.029), malnutrition (p = 0.001), type of addiction (p = 0.001), and geographic location (p = 0.001) showed significant correlations.

Conclusion: Abdominal tuberculosis severity is significantly influenced by factors like diabetes, malnutrition, type of addiction, and geographic location but not with socioeconomic status, gender, and residence.