FACTORS CONSTRIBUTING TO UNDERNUTRITION AMONG ADULTS WITH

TUBERCULOSIS AGE 18-59 YEARS, IN KAPSABET COUNTY REFERRAL

HOSPITAL.

BY

SALVIH,MLZXNE JEPLETING

COLLEGE NUMBER: D/UPNUT/19002/022

A RESEARCH DESSERTATION SUBMITTED AS PARTIAL FULLFILLMENT FOR

THE AWARD OF DIPLOMA IN NUTRITION AND DIETETICS, FACULTY OF
PUBLIC HEALTH AT KENYA MEDICAL TRAINING COLLEGE KAREN.

FEBRUARY 2020

1
 DECLARATION.

I hereby declare that this is my original work and has never been presented for the award of
Diploma in any other college.

Signature. Date

........................ .............

SALVINE JEPLETING.

Supervisor approval.

Signature. Date

...................... .................

FLORENCE ODEKE.

ii
 DEDICATION

I dedicate this work to my beloved parents, my brothers and sisters, my friends and to all who
supported me through the development of the work.

ACKNOWLEDGEMENT.

I express my sincere gratitude to the almighty God for His mercies and care throughout my study
journey, secondly I express my gratitude to my beloved parents, my brothers and my sisters for
the total support they gave me throughout my academic studies. My thanks also goes to KMTC
Karen Campus for giving me and opportunity to pursue my diploma in Nutrition and Dietetics.
My special thanks also goes to my supervisor madam Florence Odeke who fully gives me

iii
guidance and directions for the success of research,I also gives thanks to Kapsabet County
Referral Hospital who gaves me the permission to collect my data,Finally I also give my thanks
to my fellow classmates, my friends for the moral support they gave me throughout the journey
of writing and developing my research proposal.

TABLE OF CONTENTS

DECLARATION.............................................................................................................................ii
DEDICATION...............................................................................................................................iii
ACKNOWLEDGEMENT..............................................................................................................iv
TABLE OF CONTENTS................................................................................................................v
OPERATIONAL DEFINITION OF TERMS..............................................................................viii
ACRONYMS..................................................................................................................................ix
ABSTRACT....................................................................................................................................x
CHAPTER ONE..............................................................................................................................1
1.1 BACKGROUND OF THE STUDY..........................................................................................1
1.2 PROBLEM STATEMENT........................................................................................................2

iv
1.3 GENERAL OBJECTIVES........................................................................................................3
1.4 SPECIFIC OBJECTIVES..........................................................................................................3
1.5 HYPOTHESIS...........................................................................................................................3
1.5 RESEARCH QUESTIONS.......................................................................................................4
1.7 SIGNIFICANCE OF THE STUDY..........................................................................................4
1.8 SCOPE OF THE STUDY..........................................................................................................4
1.9 LIMITATION OF THE STUDY...............................................................................................4
1.10 JUSTIFICATION OF THE STUDY.......................................................................................4
1.11 CONCEPTUAL FRAMEWORK............................................................................................5
CHAPTER TWO.............................................................................................................................6
Literature Review............................................................................................................................6
2.1 Introduction................................................................................................................................6
2.1.1 Undernutrition.................................................................................................................6
2.1.3 KNOWLEDGE ON TB...................................................................................................7
2.2 .0 DIAGNOSIS OF TUBERCULOSIS..............................................................................8
2.2.1 ACTIVE TB....................................................................................................................8
2.3.0 GROUPS AT RISK OF ACQUIRING TB............................................................................8
2.3.1 INJECTING DRUG USERS (IDUS)..............................................................................8
2.4.0 SOCIA-ECONOMIC AND DEMOGRAPHIC FACTORS...........................................9
2.4.1 AGE.................................................................................................................................9
3.0 CHAPTER THREE:................................................................................................................12
research methodology....................................................................................................................12
3.1 study area.................................................................................................................................12
3.1.1 administration boundaries.............................................................................................12
3.1.2 population and demographic profile..............................................................................12
3.1.3 CLIMATE AND WEATHER.......................................................................................12
3.1.4 ECONOMIC ACTIVITY..............................................................................................13
3.1.5 HEALTH FACILITIES.................................................................................................13
3.1.6 EDUCATION................................................................................................................13
3.1.7 TRANSPORTATION...................................................................................................13
3.1.8 RELIGION AND TRADITIONAL CULTURE...........................................................14
3.2.0 STUDY DESIGN..........................................................................................................14

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 3.2.1 STUDY POPULATION................................................................................................14
3.2.3 INCLUSION CRITERIA..............................................................................................15
3.2.4 EXCLUSION CRITERIA.............................................................................................15
3.2.5 MEASUREMENTS OF VARIABLES.........................................................................15
3.2.5 DATA COLLECTION TOOLS....................................................................................15
3.2.6 SAMPLE SIZE..............................................................................................................15
3.2.7 SAMPLING TECHNIQUE...........................................................................................16
3.3.0 DATA COLLECTION..................................................................................................16
3.3.1 DATA MANAGEMENT..............................................................................................17
3.3.1.1 data entry....................................................................................................................17
3.3.1.2 data analysis.......................................................................................................................17
3.4.0 VALIDITY AND RELIABILITY................................................................................17
3.4.1 Validity..........................................................................................................................17
3.4.2 reliability.......................................................................................................................17
3.4.1 ethical consideration......................................................................................................17
4.0 CHAPTER FOUR...................................................................................................................18
4.1 Analysis...................................................................................................................................18
5.0 CHAPTER FIVE.....................................................................................................................48
5.1 Social Economic And Demographic Factors...........................................................................48
5.3 Level Of Education..................................................................................................................48
5.5 Living Status............................................................................................................................49
5.6 Lifestyle Factors......................................................................................................................49
5.6.1 Alcoholism And Smoking.............................................................................................49
5.7 Nutrition Status........................................................................................................................49
5.8 Feeding Practices.....................................................................................................................49
6.0 CHAPTER SIX........................................................................................................................50
CONCLUSION AND RECOMMENDATION............................................................................50
6.1 Conclusion...............................................................................................................................50
6.2 Recommendation.....................................................................................................................50
APPENDIX 2 Budget....................................................................................................................52
APPENDIX 3: PERSONAL CONSENT......................................................................................52
References......................................................................................................................................60

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 OPERATIONAL DEFINITION OF TERMS.

Airborne infections: Type of infections that happens when liquid parts of a cough, sneezing
containing viruses or bacteria evaporates, scatters as small.

TUBERCULOSIS: It is an infectious disease that is caused by a bacteria called Mycobacterium

tuberculosis that affects some parts of the body but mostly lungs.

Direct observation treatment short-course-dots:An anti-TB strategy formulated by WHO to find

and to cure patients.

UNDERNUTRITION: Outcome of insufficient of food intake and an adequate nutrient related to

repeated infections, it’s include being underweight for someone’s aged.

MULTIGRUG RESISTANCE TB: TB disease caused by bacteria resistance of the most

important medicine Isonaizid and Rifampicin.

EXTENSIVELY DRUG RESISTANCE OF TB(XDR-TB): TB due to bacteria that is multidrug

resistant and also resistance to injection of drugs and it is more difficult to treat.

ACRONYMS

TB. Tuberculosis

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DLTLD. Division of leprosy,Tuberculosis and Lung Disease

WHO. World Health Organisation

DOTS. Direct Observed Treatment

MDRTB. Multidrug Resistant TB

HIV. Human Immunodeficiency Virus

BCG. Bacilli Calmette Guerin

NGOs. Non-Govermental Organisations

AIDS. Acquired Immune Deficiency Syndrome

TST. Tuberculosis Skin Test

IGRAS. Interferon Gamma Release Assays

ABSTRACT

Undernutrition and TB are both problems of considerable magnitude in most of the developing
countries or some regions of the world. The two tends to interact to one another. TB mortality
rate of adults in a community tend to vary inversely with their socioeconomic levels. Acute
malnutrition in Tuberculosis can lead to secondary immunodeficiency that increases
susceptibility of other infections by the host, reduced appetite, nutrient mal-absorption of
micronutrients and the macronutrients in the body and altered metabolism leading to
undernutrition among adults aged between 18 to 59 years.

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A cross sectional descriptive design where used and the study was carried out in Nandi county.
Weight for height of adults aged 18-59 years was measured to determine the nutritional status,
data was collected using researcher’s administrative questionnaire and analyzed using
frequencies, mean and percentages.

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 CHAPTER ONE

1.1 BACKGROUND OF THE STUDY

Tuberculosis (TB) is an infectious disease caused by bacteria known as Mycobacterium
tuberculae. TB is transmitted through coughing or sneezing by an infected person when it gets
exhaled into the air. TB mostly affect the lungs and is fatal if not treated. However about one
quarter of the world's population have latent TB which means they have been infected by the
bacteria but they do not present with the symptoms of the disease and cannot transmit the
disease(WHO). World health organization (WHO) stated that TB mostly affect adults in their
reproductive years. However, all groups are at risk of being infected with TB, over 95% cases
and deaths are in the developing countries including Kenya.

People who are HIV infected are 20 times more likely to develop Active TB. The risk of
developing Active TB is also greater in people suffering from other conditions that impairs
immune system. People with undernutrition are three times more at risk. Globally 2.3 million
people were newly infected with TB as a result of undernutrition, (WHO,2018).

In 20 March 2019 TB remained the leading cause of death from infectious disease according to
(WHO). WHO reports that TB is among one of the top ten causes of death worldwide. In
2018,10 million people felt sick with TB and 1.5 million died from the disease (including
251000 among people with HIV).1.1 million estimated children get were infected with TB and
251000 died of TB (including children with HIV associated). TB is a leading killer of HIV-
positive people.

Nationally Kenya is one of the most countries with the high burden of TB, HIV/TB and
Multidrug-resistant TB. Kenya is estimated to detect 72% of bacteriologicallcally confirmed TB
and 80% of all cases(WHO,2016).In 2015, the estimated prevalence of all forms of TB was 233
per 100000 population while the mortality from all forms of TB was 20 per 100000 population
(WHO,2016). Kapsabet County Referral Hospital, there were 1287 records from patient with TB
register initiated on treatment between January 1 2013 and June 30 2014 in Nandi County.
(panafrican-med-journal.com).

TB has many consequences including, increased calorie requirements, body’s reduced ability to
utilizes fats, muscle wasting, reduce intake due to reduced immunity. Interventions recommend

x
Isoniazid drugs for TB people with HIV (by WHO). NGOs seek to prevent HIV associated
infections and TB, by providing care for PLWHIV\AIDS and TB.

1.2 PROBLEM STATEMENT.

Tuberculosis is a major public health problem worldwide, especially in low and middle income
countries, Kenya being part of this countries.one third of the world population is affected with
mycobacterium tuberculosis and ten million develop active form of the disease each year
resulting in two million deaths globally in 2017.Active TB can led to loss of weight as a results
of nutrient deficiency including proteins due to their breakdown to be used in the synthesis of
immune bodies resulting in protein wasting. It's also leads to increase nutrient requirements due
to loss of nutrients through blood sputum and increase in body temperature. Tuberculosis is
associated with various socioeconomic factors such as poverty and economic deprivation which
led to poor nutritional status of a patient resulting in immune function impaired,
(Dargie,B.,Tesfaye,2016)

Undernutrition in TB patients is as a results of factors such as loss of appetite, nausea and also
abnormal pain (Global health estimate,2019) reduced food intake due to excessive coughing and
also as a results of food and nutrient interaction with ant-TBs. Undernutrition increases the
frequency and severity of many infections including tuberculosis. Many studies show an inverse
and exponential relationship between BMI and incidence of TB (Lo"nnroth et al,2010)
Undernutrition is widely prevalent comorbidity in people with TB and increase the risk of more
severe disease, death, mal-absorption of ant -TB drugs and relapse after cure. WHO and other
organization made recommendation for nutrition support in patient with
tuberculosis(WHO,2013).Nationally the TB treatment success rate is at 85.5% while Nandi
county lags behind at 77%.(international journals of scientific and research publication, April
2016)this is still a challenge in Nandi county, furthermore a research was done in 2016 in Nandi
county and it was found out that treatment interruption is also a key and it is associated with lack
of knowledge on the risk of interrupting TB treatment with herbal medicine, this is common in
areas with low level of education where they still believed in witchcrafts on lack confidences in
ant -TBs this was also increase the burden of TB in Nandi. Stigma is also a problem on
tuberculosis patients fear to seek prompt treatment and health seeking practices (Author:Alfred
Wandeba Wanyonyi,2016) a lot of effort is still needed concerning this to reduced cases of drug

xi
interruption, and also counselling on knowledge on nutrition to reduce and prevent cases of
undernutrition on tuberculosis patients.

1.3 GENERAL OBJECTIVES

To determine factors contributing to undernutrition among adults with TB, age 18-59 years in
Kapsabet County Referral Hospital Nandi county.

1.4 SPECIFIC OBJECTIVES

To determine the socioeconomic factors related to transmission of TB among adults of 18-59
years in Kapsabet County Referral Hospital.

To determine factors contributing to undernutrition among adults of 18-59 years with TB in

Kapsabet County Referral Hospital.

To determine nutritional status of adults with TB in Kapsabet County Referral Hospital.

To assess the nutritional knowledge amongst adults of 18-59 years with TB,in Kapsabet County
Referral Hospital.

1.5 HYPOTHESIS
HO: There is no significant relationship between nutritional status and socioeconomic status in

adults with TB.

1.5 RESEARCH QUESTIONS

What is the social economic status of adults with TB in Kapsabet County Referral Hospital?

What is the nutritional status of adults with TB in Kapsabet county Referral Hospital?

1.7 SIGNIFICANCE OF THE STUDY

The study findings enable the government and the ministry of health (MOH) to provide high
quality preventive measures for TB patients. The findings of this study is beneficial to the
government health professionals, NGO and donor agencies working in the region and kapsabet
community in planning, implementing and assessing health education and health programs for
TB patients. The study is significant to the researchers also as they will use it as a reference tool
when undertaking the same study.

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1.8 SCOPE OF THE STUDY
The study was carried out among adults aged 18-59 years with TB in Kapsabet County Referral
Hospital Nandi county.The finding was only carried out among adults attending hospital.

1.9 LIMITATION OF THE STUDY.

The research findings can only be applied by the researchers undertaking the same study.

Some of the respondents was not willing to participate in the study.

1.10 JUSTIFICATION OF THE STUDY.

Tuberculosis is a major public health problem worldwide, more so in developing countries,
Kenya being one of them. Nandi County suffer a burden of 96^12 TB prevalence (per 100000
people) and33^12 TB incidence (per 100000 people), according to (Health at Glance Nandi
County may 2015).

Since TB is associated with a number of consequences such as reduced immunity, makes one to
be susceptible to infections, increases body calorie requirements due to excessive sweating. It
also reduces body's ability to utilize fats which increases protein loss. carrying out a research
concerning this was of great value to prevent and control the consequences associated with
tuberculosis, the study was carried out also to improve the nutritional status and to control or
prevent factors which contribute to undernutrition among adults with TB in Kapsabet County
Referral Hospital. The study finding will be used to serve as a tool for reference while taking the
same study.

1.11 CONCEPTUAL FRAMEWORK

Independent Variable Dependent Variable

Socio-democratic and
economic characteristics

Feeding practices

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Lifestyle practices
Nutritional status
 CHAPTER TWO

Literature Review
2.1 Introduction.
TB is an infectious disease caused by bacteria known as Mycobacterium tuberculin.TB is
transmitted through coughing or sneezing by an infected person, when it gets expelled into the
air. A person will only need a few of these bacteria to be infected when inhaled, (WHO,2007).

TB mostly affect the lungs and it is fatal if not treated. TB remains the public health concern.

Globally Tuberculosis is one of the top ten causes of death. Over 1.5 million of people died of
the disease including 251000 with HIV/Aids.25% of this deaths occur in African
region(WHO,2016). Tuberculosis/TB with HIV/Aids are the most important infectious cause of
deaths in high burden Africa. (journal of infectious disease 205, (suppl-2), s 340-s 346,2012).

Furthermore, the economic burden of TB in India is extreme between 2006&2014 with 90%
(Revised national TB control National strategic plan,2012-2017).

Nevertheless TB is a mojar concern in E.Africa,Kenya included has the highest burden of

TB,HIV with TB and Multidrug-Resistance(MDR).TB is the 5th leading cause of death, for past
one year Kenya reports 96,434 TB patients,10,086 included children with TB and 669(MDR)also
included TB cases.(March 25,2019 news).

2.1.1 Undernutrition.
Undernutrition is defined as the outcome of the insufficient of food intake and inadequate
nutrients related to repeated infections or diseases. It includes being underweight for one's age or
too short for one's age(stunting)or being dangerously thin for one's height(wasting).
Undernutrition can also be defined as deficiency in vitamins, minerals and macronutrients. (by
UNICEF.Org/progressforcl)

2.1.3 KNOWLEDGE ON TB.

2.1.3.1 MODE OF TRANSMISSION

TB is transmitted through inhaling of air droplets produced by an infected person. It's mostly
transmitted during coughing or sneezing. People with prolong frequent contact with an infected
person are at high risk of being infected with TB(Ahmed,2011). Untreated Active TB in human

xiv
beings may affect 10-15 people per year. The probability of transmission depends on several
factors i.e. duration of exposure, number of infectious droplets, effectiveness of ventilation, level
of immunity of an infected person (CDC,2011).

2.1.3.2 Signs and symptoms.

TB signs and symptoms are, chest pain and coughing that last for more than three weeks or
more, coughing up blood, chest pain or pain with breathing or coughing, unintentional weight
loss, fatigue, fever, night sweats, chills and loss of appetite, TB can also affects other parts
including kidneys, spine or brain, when TB occurs outside the lungs sign and symptoms varies
according to the organ involved, example TB of the spine is presented with, back pain and TB of
the kidney someone's presents with having blood in urine(Mayo clinic,30 January 2019).

2.1.3.2 EPIDEMIOLOGY
Tb is one of the top ten leading cause of death. About one quarter of word's population have been
infected with latern tuberculosis. Globally TB incidence is falling at about 2% per year which
needs to accelerate to 4-5% annual decline. WHO reports that 58000000 million lives saved
between 2000-2018,10000000 million fell ill in 2018 and 484000 people ill with drug -resistant
TB. However new cases of TB trend on 202 countries. Over 25% cases of deaths occurs in
Africa (Kenya of glance KANCO,march 2019)Kenya being part of this. Kenya decline in the
number of all forms of TB at a rate of 1% because of effective control
interventions(DLTDL,2011).

2.2 .0 DIAGNOSIS OF TUBERCULOSIS

2.2.1 ACTIVE TB.
Active TB is diagnosed based on medical examination i.e sign and symptoms,chest rediography
which dectect chest abnormalities that results in Pulmonary TB.Culture method is also used to
diagnosed Active Tuberculosis,(C.D.C,2010 UN).

2.2.1.2 LATENT TB.

Monteux Tuberculin Skin Test(TST) often used for patient immunized and gives false positive
results. Interferon Gamma Release Assays(IGRAS) on blood sample is recommended for patient
who gives positive(TBT). IGRAS increases the sensitivity when used together with TST.
(C.D.C, 2010 UN).

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2.2.1.3 TREATMENT OF TUBERCULOSIS.
Anti-TB drugs is prescribed to treat the disease. The treatment consists of four drugs; Isoniazid,
Rifampin, Pyrazinamide and Ethambutol. The minimum length for the treatment of susceptible
TB drug with Rifampin-based regimen is 6-9 months. This is recommended for all patients with
TB. Patients’ needs to adhere to drugs medications to ensure high completion rate of drugs,
control and prevent the transmission of the disease and also prevent emergency drug resistant
cases. The preferred regimen for treatment of Latent TB is 9 months of Isoniazid drug, (Jama ,
2005)

2.3.0 GROUPS AT RISK OF ACQUIRING TB.

2.3.1 INJECTING DRUG USERS (IDUS).
IDUS experience high prevalence of TB acquired as a results of social and demographic factors

associated with, i.e poverty, homelessness, unemployment, HIV/AIDS associated cases and also
inadequate access to health care services(WHO,2011).

2.3.1.1 DISPLACED POPULATIONS

Due to poor living conditions, overcrowding in a refugee camp or slums settlement increases the
risk of TB transmission from one person to another as a results of poor environmental conditions
and awareness on TB prevents and control measures. The world's growing number of refugees
and displaced persons are at risk of both TB and inadequate TB treatment, (CDC,MMWR
Famine).

2.3.1.2 ITINERANT GROUPS.

Mobile communities, Gypsies and Travelers are at high increase risk of TB transmission due to
poor living conditions i.e in overcrowded environment, lack of awareness accelerates the disease,
poor access to health care services is also a major factor for the itinerant groups(FAO,WHO
2010).

2.3.1.3 HIV/AIDS.
People living with HIV/AIDS (PLWHIV/A) are 20 times more likely to developed active TB

because of weak compromised immune systems. PLWHIV are prone to being malnourished due
to associated opportunistic infections(OI's) which leads to increased nutrient requirements,
undernourished people are 3% at risk of being infected(WHO,2018).

xvi
2.3.1.4 CO-INFECTION.
People living with HIV/AIDS are 20 times more likely to developed Active TB than people
without HIV, as a results of compromised immune system. Both HIV/AIDS and TB accelerate
one other which results in increased disease progression. As a results latent TB is more likely to
advance to active TB in people with HIV/AIDS, than people without HIV. Treatment of HIV
using Antiretroviral therapy (ART) protects the immune system and reduces latent TB from
advancing from latent to activate TB, (UN CDC,23 May 2019).

2.4.0 SOCIA-ECONOMIC AND DEMOGRAPHIC FACTORS.

2.4.1 AGE.
WHO, stated that TB mostly affect adults in their reproductive years. Furthermore, all groups are
at risk of being infected. Which results in 95% cases of deaths occurs in developing countries.
Mostly Mycobacterium Tuberculosis attacks the reproductive age groups compared to elderly.
This is because this groups are economically productive individuals thus tuberculosis has a
potential to impede the development of the society. The present study demonstrate 69% patients
are <40 years. This co-relates other studies done in Pakistan and other countries (Ahmad,2013;
Rajeswari et al.,1999,Hameed at Al,2015)

2.4.1.1 INCOME LEVEL.

Tb is often known as "disease of the poor" because the burden of TB follows strong low socia-
economic gradient both within and between the poorest communities and countries in Africa. As
a results of poverty, poor working conditions, African behaviors, exposure to indoors air
pollutions, overcrowding and high prevalence of HIV/AIDS. All these are the risk factors
associated with income level. (Derva,M.Barter et.al,14 November 2012).

2.4.1.2 OCCUPATIONAL FACTORS.

Tuberculosis is a known occupational hazards for health care workers(HCWs) especially in
countries with high prevalence rate for TB. It is estimated that HCWs have 2-3 fold increased
risk of developing TB, compared to the general populations. (26April 2016-oxford journals).

xvii
2.4.1.3 EDUCATIONAL LEVEL.
Illiteracy increases the risk and the spread of TB transmission from one person to another as a
results of lack of awareness on preventive and control measures to prevent disease transmission.

2.4.1.4 GENDER.
Males and young adults, ages of 21-35, have a greater awareness about tuberculosis transmission
and prevention of TB than females and adults over 35 years. This also counter interact with
people with higher education and urban areas individuals have a better information about TB.
They have greater knowledge on tuberculosis and are also less likely to experience delays in
seeking treatment. (Africa Health sciences, makerere University medical school)

2.4.1.5 NUTRITIONAL STATUS.

Patient with poor nutritional status (undernutrition) are three times more likely to develop TB,
because of general weak immune system. Undernutrition can lead up to 2.3 million people newly
diagnosed with TB.

2.4.1.6 FEEDING PRACTICES.

Poverty and food insecurity is a major key that leads to inadequate food intake. Inadequate food
intake is an immediate factor for malnutrition(undernutrition). Poor nutritional status weakens
immune system thus makes a person susceptible to infections. TB patients have poor feeding
practices due to consequences associated with the disease i.e. poor appetite, altered metabolism,
nutrient malabsorption. All this might lead to increased risk of TB progression from latent to
active TB.

xviii
 3.0 CHAPTER THREE:

research methodology.
3.1 study area.
3.1.1 administration boundaries.
Nandi County is about 2884 kilometer square. It's borders Baringo to the east, Vihiga and
Kakamega to the west, Uasin Gishu to the north,Kisumu to the south and Kericho to the
southeast.

Nandi county is divided into six constituencies: Emgwen, Mosop, Chesumei,Tindiret,Nandi Hills
and Aldai. Nandi county is also divided into six districts which include: Nandi central, Nandi
south, Nandi east, Nandi north and Tinderet.

3.1.2 population and demographic profile.

Nandi County has 272,965 people, a ratio of 1:1male and female according to national census
2009, majority of the people who live in Nandi County are the Nandi people, a Kalenjin sub
group in Kenya. Other Kalenjin sub tribes living in Nandi are kipsigis ,tugen, terich and
others.Other communities who also live in nandi are: Kikuyu, luhya, luo, kisii .Most of whom
work on tea plantation, factories and others employed by the county government and private
companies. Nandi people mainly practice subsistence agriculture, livestock raring and many
have turn to cash crop farming such as tea, coffee, sugarcane and maize, Nandi people practice
this to supplement their income.

3.1.3 CLIMATE AND WEATHER.

Nandi County has cool and wet climate with two rainy seasons, the longer rainy season and the
shorter rainy seasons, that is between March and August and between October and November
respectively. Rainfall vary between 1200 mm and 2000 mm annually with temperature between
15 and 25degree census.

3.1.4 ECONOMIC ACTIVITY.

Nandi County has cool weather complimented by rich volcanic soil that makes an ideal area for
tea, maize and sugar cane farming. The county has a large tea plantation especially in areas
around Nandi Hills town, coffee is also planted in some other parts of Nandi South. Dairy animal
husbandry is also a major source of income earning in Nandi county residents. The county also

xix
has huge potential to develop sports tourism owing to its association with internationally
renowned athletes.

3.1.5 HEALTH FACILITIES.

Nandi county have several facilities, Kapsabet being the county referral hospital, Nandi Hills sub
county hospital, Kaptumo district hospital, Mosoriat and other 9 health centers and 45
dispensaries with a doctor population ratio:1: 94000.There is a certainly a need for more health
facilities to be established to cater for its residents.

3.1.6 EDUCATION.
The county has about 744 primary schools and 155 secondary schools with about 220 000 pupils
and 27 000 students respectively. Nandi county is a home of some Kenyans best schools i.e
Kapsabet high school and Kapsabet girls. There is also institutions of higher learning in the
county such Baraton University, Koitalel University,Mosoriot Teachers College,Mosoriot and
Kaptumo Kenya Medical Training College and some other institutions.

3.1.7 TRANSPORTATION.
The most available means of transport within the county is roads. The county has tarmac roads
that connect major Kenya towns i.e Eldoret ,Nakuru, Nairobi, Kakamega, Kisumu,and kericho
town. County has means by air transport the nearest being Eldoret international airport. Nandi
county has also many marram roads that provide all weather movement throughout the year.
Public transport is by buses, matatus and motorbikes.

Nandi county has several tourist attractions including: chepkit waterfalls, bonjoge game reserves,
kobujoi forest, kingwal swarm and koitalel samoei musium in nandi hills town.

3.1.8 RELIGION AND TRADITIONAL CULTURE.

Traditionally Nandi believed in Supreme god "cheptalel" or "asis " which symbolized the god of
the sun, however Nandi people currently have abandoned their traditional believes and turn to
Christianity and few converting to Muslims. Most popular churches set among Nandi county are
Africa inland Church(AIC), Anglican Church of Kenya(ACK)Full Gospel Churches of Kenya
and also Catholic Churches.

xx
Traditionally ugali was a stable food which was usually served with "kienyeji"vegetables and
"mursic"femented milk. The people of nandi also used to wear clothes made from domestic
animal skins, they also donned earrings. Compromising heavy brass coils that pulled their
earlobes down this was done to both men and women. Nandi practice circumcision to girls and
boys as a rite of passage into adulthood and the boys was assigned the task of defending the
community while girls get into marriage. Female circumcision is no longer practice any more.
Currently education is highly valued.

3.2.0 STUDY DESIGN.

A cross sectional design was used in the study to determine the factors contributing to
undernutrition among adults with tuberculosis aged between 18 and 59 years in Kapsabet County
Referral Hospital, Nandi County.

3.2.1 STUDY POPULATION.

The study population was based on the factors contributing to undernutrition in adults with TB in
kapsabet county referral hospital, the factors include socio economic factors, socio demographic
factors, poor feeding practices and others.

3.2.3 INCLUSION CRITERIA.

All adults of aged between 18 and 59 years attending kapsabet county referral hospital were
included.

3.2.4 EXCLUSION CRITERIA.

The adults or any other person outside the age brackets was not included, together with those
adults within the bracket and have TB but are not attending the hospital are also excluded.

3.2.5 MEASUREMENTS OF VARIABLES.

Dependent variable is the nutritional status, the depend on the independent variables i.e socio
demographic and economic characteristics, feeding practices, health seeking practices, lifestyle
practices and the knowledge on nutrition. All these measures different variables for example
social economic measure aged, gender, marital status and even the size of the household, and the
feeding practices,measure on the patient’s lifestyle and the feeding frequency of the respondents.

3.2.5 DATA COLLECTION TOOLS.

The method of data collection is by use of a questionnaire. The questions include the feeding

xxi
practices of adults living with tuberculosis, their nutritional status, their socio economic and
demographic characteristics e.t.c.

3.2.6 SAMPLE SIZE.

Simple random sampling was used to attain the sample size required by adults with tuberculosis
attending kapsabet county referral hospital.

The use of fishers’ method was used. (fishers,1998).

Where n=z^2pq

d^2

n=Desired sample size.

z=Standard normal deviasion at 1.96.

p=prevalence/proportion of the targeted polupation estimated to have characteristics being

measured, where by the estimated prevalence is (96^11)which is(6.12709) and the estimated
prevalence is 6.

q=population without characteristics being measured (1_p).

D=degree required for the accuracy which is at 0.05^2.

There for 1.96^2*0.06*(1_0.06)

0.0025

n=86.6

=87 respondent.

3.2.7 SAMPLING TECHNIQUE.

Random sampling technique was used, which has every adult age between 18 and 59 years
presented with malnutrition that is undernutrition in tuberculosis, a chance of being sample. The
method also involved use of a questionnaire where by the sample group filled the questionnaire.

xxii
3.3.0 DATA COLLECTION.
The method used to collect data was by use of a questionnaire. The questions include the
nutritional status of the adults with malnutrition (undernutrition specifically) with Tuberculosis,
their feeding practices and also their social and demographic factors.

3.3.1 DATA MANAGEMENT.

3.3.1.1 data entry.
The data was entered in Microsoft word

3.3.1.2 data analysis.

Data was analyzed using SPSS.

3.4.0 VALIDITY AND RELIABILITY.

3.4.1 Validity.
Validation of data collection instruments was done to ensure the degree to which the instruments
collects the correct data purported to measure. The questionnaire was reviewed by the supervisor
before data is collected to ensure meets the correct validation.

3.4.2 reliability.
Reliability of the research documents was established during the pretesting of the data
collections. The questionnaire tests only adults with tuberculosis between ages of 18 and 59
years of age, and if the questions involved in the questionnaire was answered well, and the
questionnaire was considered reliable for the study.

3.4.1 ethical consideration.

The information collected was private to all the respondents, the names was not taken. Numbers
was given to ensure confidentiality throughout the process of data collection.

3.4.1.1 data presentation.

The data was presented using tables, pie charts and also bar graphs.

xxiii
 4.0 CHAPTER FOUR

4.1 Analysis
This chapter shows the analysis of the findings from the questionnaires administered to the
respondents which involved a number of 87 respondents; there was a 100% response to the
questions provided in the questionnaire except exclusive case or the leading cases. The analysis
was presented by the use of tables and bar graphs as well.

Table 4.1 Gender of the respondent

Valid Cumulative
Frequency Percent Percent Percent

Valid Male 46 52.9 52.9 52.9

Female 41 47.1 47.1 100.0

Total 87 100.0 100.0

The level of response in this study comprised of 52.9% who were male and 47.1% were female,
this shows that the patients interviewed comprised of large population as male and a few number
of female as depicted in the table 4.1 above.

xxiv
 Female
47% Male
53%

Male Female

120

100

80

18-30 yrs.
60 31-40 yrs.
41-50 yrs.
51-59 yrs.
40

20

0
1 2 3 4

Figure 4.1 Gender of the respondent

The analysis of the age of the respondent were varying as shown in the figure above, most of the
respondents interviewed lied between the age of 31years and the age of 40 years as shown in
table 4.2 below, the lowest population interviewed in this case were those of age lying between
51 years and 59 years of age with a percentage of 10.3%, the youthful age of 18-30 years
recorded up to 24.1% of the total population interviewed and those of age 41-50 years adding to
26.4% of the total patients interviewed. The distribution of the respondents in their age had a
variedly represented distribution.

xxv
4.2 Age of the respondent

Valid Cumulative
Frequency Percent Percent Percent
Valid 18-30 yrs. 21 24.1 24.1 24.1
31-40 yrs. 34 39.1 39.1 63.2
41-50 yrs. 23 26.4 26.4 89.7
51-59 yrs. 9 10.3 10.3 100.0
Total 87 100.0 100.0

Distribution of Age the respondent

51-59 yrs.
10%
18-30 yrs.
24%

41-50 yrs.
26%

31-40 yrs.
39%

Figure 4.2 Age of the respondent

Table 4.3 Marital status

xxvi
 Valid Cumulative
Frequency Percent Percent Percent
Valid Single 28 32.2 32.2 32.2
Married 47 54.0 54.0 86.2
Widowed 12 13.8 13.8 100.0
Total 87 100.0 100.0

The respondents’ marital status was also considered in this case, most of the respondents were
married as represented by 54% followed by 32.2% who were single and the least group who
were widowed were adding up to 13.8% as shown in the table above.

Table 4.4 Highest level of education

Valid Cumulative
Frequency Percent Percent Percent
Valid None 23 26.4 26.4 26.4
Primary 38 43.7 43.7 70.1
Secondary 19 21.8 21.8 92.0
Tertiary 7 8.0 8.0 100.0
Total 87 100.0 100.0

Most of the respondents had their highest level if education as primary with the highest
percentage followed by those who did not get any formal education who were 26.4% and those
who acquired secondary education were 21.8% and the ones who ever attained tertiary level
education were the least number with 8% of the total respondents interviewed.

xxvii
 Highest level of education

Tertiary
8%
None
26%

Secondary
22%

Primary
44%

Figure 4.4 Highest level of education

120

100

80

None
60 Primary
Secondary
Tertiary
40

20

0
Frequency Percent Valid Percent Cumulative Percent

Table 4.5 People living permanently in the household

xxviii
 Valid Cumulative
Frequency Percent Percent Percent
Valid 0-5 28 32.2 32.2 32.2
6-10 42 48.3 48.3 80.5
11-15 17 19.5 19.5 100.0
Total 87 100.0 100.0

The respondents were also inquired on the number of the permanent members living in their
household and were found that most of the respondents have household members of between 6
and 10 represented by 48.3% as in the table above. This is followed closely by those who are less
than 5 members in the household having 32.2% and the least number of the respondents were
found to be having 11-15 members of the household represented by 19.5% of the total response.
This summery is also presented in the table below.

xxix
Table 4.6 Type of the house living in

xxx
 Valid Cumulative
Frequency Percent Percent Percent
Valid permanent house 21 24.1 24.1 24.1
semi-permanent 62 71.3 71.3 95.4
homeless 4 4.6 4.6 100.0
Total 87 100.0 100.0

The statistics in the type of the houses the respondents were living was also put in consideration
and most of them were living in a semi-permanent house whom were represented by 71.3% of
the total respondents, and 24.1% were living in permanent houses, it was noted that 4.6% of the
respondents did not own any houses at all this could have been living in streets. The presentation
was shown in the table above.

Is the home adopted to your needs

Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 55 63.2 65.5 65.5
No 29 33.3 34.5 100.0
Total 84 96.6 100.0
Missing System 3 3.4
Total 87 100.0
Most of the respondents had their homes adapted to their needs as shown in the table above and
33.3% of the response has their homes not adapted to their needs while those not captured were
the few who had no households.

xxxi
If no do you have the problem with it
Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 24 27.6 85.7 85.7
No 4 4.6 14.3 100.0
Total 28 32.2 100.0
Missing System 59 67.8
Total 87 100.0

For those who do not have their homes adapted to their needs 85.7 said that they have problem
with that as they affect their livelihoods, thus a few of them said that they don’t have any
problem with that as they don’t affect their daily livelihoods.

what do you consider a control to diabetes

Valid Cumulative
Frequency Percent Percent Percent
Valid Medication 29 33.3 33.3 33.3
Diet and
23 26.4 26.4 59.8
exercise
Don't know 35 40.2 40.2 100.0
Total 87 100.0 100.0
A control measure that is possible to diabetes was asked to the respondent and it was found that
most of them don’t know any control measure of diabetes recording 40.2% of the respondents,
however, 33.3% of the respondents agreed that medication is a control measure of diabetes while
the rest 26.4% had the opinion that a control measure is the diet and bodily exercise is a
preventive measure of diabetes as depicted in the figure below.

xxxii
 120

100

80

Medication
60
Diet and exercise
Don't know
40

20

0
Frequency Percent Valid Percent Cumulative Percent

Table 4.7 Maintaining weight is important in TB management

Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 33 37.9 37.9 37.9
No 54 62.1 62.1 100.0
Total 87 100.0 100.0
The respondents were asked as to whether it is important to maintain weight as a management of
TB and 62.1% disagreed with the same as 37.9% agreed that maintaining weight is important to
control and management of B.This is presented in the table above.

Do you know about carbohydrates as nutrient

Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 59 67.8 67.8 67.8
No 28 32.2 32.2 100.0
Total 87 100.0 100.0
It was found that most of the respondents know carbohydrates as nutrient whereas few of them
adding up to 32.2% do not know carbohydrates as nutrients; this showed the level of knowledge
in the nutrition status of the respondents as shown in the table above.

xxxiii
 DO YOU KNOW CARBOHYDRATES AS NUTRIENTS

32% Yes
No

68%

80

70

60

50

40 Yes
No
30

20

10

0
1 2

The information was further collected on those responded that knew carbohydrates as nutrients
and the following was found;

xxxiv
If yes , is it important for TB patient
Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 14 16.1 48.3 48.3
No 15 17.2 51.7 100.0
Total 29 33.3 100.0
Missing System 58 66.7
Total 87 100.0
Most of the respondents said that carbohydrates are not important for TB patients while the other
agreed that carbohydrates are important for TB patients as shown in the table above. Those
66.7% missing in the system didn’t know carbohydrate as a nutrient in early quiz.

Do you know vitamins as a nutrient

Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 48 55.2 55.2 55.2
No 39 44.8 44.8 100.0
Total 87 100.0 100.0
It was found that the patients interviewed agreed that they know vitamins as nutrients this shown
by 55.2% agreeing in the table above and the figure below, whereas 44.8% do not know vitamins
as nutrients.

60

50

40

Frequency
30 Percent

20

10

0
Yes No

xxxv
if yes do you know why it is important
Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 31 35.6 54.4 54.4
No 26 29.9 45.6 100.0
Total 57 65.5 100.0
Missing System 30 34.5
Total 87 100.0
Most of the respondents that knew vitamins as nutrients know their importance as shown in the
table above while the other 29.9% do not know why vitamins are important nutrient.

Do you know to interpret dietary prescription

Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 47 54.0 54.0 54.0
No 40 46.0 46.0 100.0
Total 87 100.0 100.0

KNOW DIETARY INTERPRETATION

Yes No

xxxvi
A question posed to the respondent as to whether they know to interpret dietary prescription and
was found that most of them up to 54% know while the rest 46% of them didn’t have knowledge
on the interpretation of prescription. The findings was further presented in the figure below.

100

90

80

70

60
Yes
50
No
40

30

20

10

0
Frequency Percent Valid Percent Cumulative Percent

if no do you know do you have someone who can do it for you

Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 27 31.0 67.5 67.5
No 13 14.9 32.5 100.0
Total 40 46.0 100.0
Missing System 47 54.0
Total 87 100.0
Most of the respondents who don’t know to interpret their dietary prescription have someone
who can interpret for them as presented as 31% and 14.9% don’t have someone to interpret for
them as far as dietary prescription is concerned. The figure below gives presentation on the
prescription.

xxxvii
 120

100

80

Valid Yes
60 Valid No
Valid Total
Missing System
40

20

0
Frequency Percent Valid Percent Cumulative Percent

Table 4.8 Being drunk while suffering TB drugs is not a serious problem

Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 38 43.7 43.7 43.7
No 49 56.3 56.3 100.0
Total 87 100.0 100.0
On whether being drunk while suffering TB drugs is a serious problem or not, it was also found
that most of them disagree as recorded by 56.3% of the respondents while 43.7% agreed that
being drunk while suffering from TB is not a serious problem as depicted in the table above.

Table 4.9 Number of meals per day

xxxviii
 Valid Cumulative
Frequency Percent Percent Percent
Valid 2 30 34.5 34.5 34.5
3 43 49.4 49.4 83.9
4 10 11.5 11.5 95.4
More than 4 4 4.6 4.6 100.0
Total 87 100.0 100.0
The response on the number of meals taken by the patients were as follows; 49.6% of the
respondents takes three meals per day this is followed by 34.5% who said they take meals twice
a day and 11.5% take meals four times in a day and the rest 4.6% take more than four meals per
day as shown in the table above and also in the figure below.

100

90

80

70

60
2
50 3
4
40 More than 4

30

20

10

0
Frequency Percent Valid Percent Cumulative Percent

what intervals do you take meals

Valid Cumulative
Frequency Percent Percent Percent
Valid 1-3 hrs. 38 43.7 43.7 43.7
4-6 hrs. 41 47.1 47.1 90.8
7-9 hrs. 8 9.2 9.2 100.0
Total 87 100.0 100.0
The intervals at which each one of them takes meals was also considered in the study and was
noted that most of them takes meals at interval of 4 to 6 hours in a day represented by 47.1%
xxxix
while 43.7% of the response take meals at interval of 1 to 3 hours in a day and a few of them
take meals at an interval of 7 to 9 hours in a day as shown in the table above.

INTERVALS OF TAKING MEALS

9%

44%

47%

1-3 hrs. 4-6 hrs. 7-9 hrs.

Do you usually take breakfast daily

Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 57 65.5 65.5 65.5
No 30 34.5 34.5 100.0
Total 87 100.0 100.0
Out of the 87 respondents interviewed, 65.5% of them take breakfast daily as shown in the table
above while 34.5% of the shows that they do not take breakfast daily as some of their factors
were their low standard of living influenced by poverty thus inability to finance their meals as
further presented in the figure below.

xl
 100

90

80

70

60
Yes
50
No
40

30

20

10

0
Frequency Percent Valid Percent Cumulative Percent

Table 4.10 Number of fruits you eat on average per day

Valid Cumulative
Frequency Percent Percent Percent
Valid none 46 52.9 52.9 52.9
1-2 29 33.3 33.3 86.2
3-4 8 9.2 9.2 95.4
More than 4 4 4.6 4.6 100.0
Total 87 100.0 100.0
Most of the respondents do not take fruits per day as shown in the figure below, this is followed
by 33.3% of whom they take between 1 to 2 fruits per day and 9.2% takes 3 to 4 fruits per day
and lastly 4.6% whom they take more than 4 fruits per day, this enables the patient to boost their
nutrition status although more than half of the were found not to be taking fruits daily.

xli
 100

90

80

70

60
none
50 2-Jan
4-Mar
40 More than 4

30

20

10

0
Frequency Percent Valid Percent Cumulative Percent

How many units of alcohol do you take

Valid Cumulative
Frequency Percent Percent Percent
Valid 1-2 glasses 12 13.8 50.0 50.0
3-4 glasses 7 8.0 29.2 79.2
5-6 glasses 4 4.6 16.7 95.8
7-9 glasses 1 1.1 4.2 100.0
Total 24 27.6 100.0
Missing System 63 72.4
Total 87 100.0
As 72.4% of the respondents were found not to be taking alcohol and of the 27.6% taking
alcohol; 13.8% were taking 1 to 2 glasses of alcohol, 8% were found to be taking 3 to 4 glasses
of alcohol, it was also found that 4.6% of the respondents were taking 5 to 6 glasses of alcohol
and the remaining 1.1% were taking between 7 and 9 glasses of alcohol as shown in the table
above.

xlii
Do you smoke
Valid Cumulative
Frequency Percent Percent Percent
Valid Yes 20 23.0 23.8 23.8
No 64 73.6 76.2 100.0
Total 84 96.6 100.0
Missing System 3 3.4
Total 87 100.0
From the study conducted it was noted that 23% of the respondents were smoking as shown in
the table above while 73.6 of them were not smoking as depicted in the table above, it was also
noted that 3.4% of the respondents did not give their views as to whether they are smoking or not
as shown in the table above.

what do you use to cook

Valid Cumulative
Frequency Percent Percent Percent
Valid Oils 35 40.2 40.2 40.2
Fats 52 59.8 59.8 100.0
Total 87 100.0 100.0

The respondents were also asked on what they use to cook and was noted that most of them use
cooking fats represented by 59.8% of the respondents while 40.2% of the other respondents were
using cooking oils as shown in the table above and also in the figure below.

xliii
 Chart Title

40% Oils
Fats
60%

what kind of bread do you eat

120

100

80

Oils
60 Fats
Total

40

20

0
Frequency Percent Valid Percent Cumulative Percent

The type of bread eaten by the respondent was also sought.

Valid Cumulative
Frequency Percent Percent Percent
Valid White bread 55 63.2 63.2 63.2
Whole meal
32 36.8 36.8 100.0
bread
Total 87 100.0 100.0

xliv
It was found from the study that most of the respondents (63.2%) were eating white bread while
few of them (36.8%) were found to be eating brown bread as shown in the table above.

How often do you eat vegetables, fruits or berries

Valid Cumulative
Frequency Percent Percent Percent
Valid Everyday 33 37.9 37.9 37.9
Not
53 60.9 60.9 98.9
everyday
3-4 times a
1 1.1 1.1 100.0
week
Total 87 100.0 100.0
The question as to how frequent do they eat vegetables, fruits or berries varied as most of them
(60.9%) do not eat vegetables, fruits and berries as shown in the table above. Quite a smaller
number (37.9%) eat vegetables, fruits and berries every day while 1.1% eats 3 to 4 times in a
week as shown in the figure below.

Chart Title

1%

Everyday
38% Not everyday
3-4 times a week

61%

xlv
 120

100

80

Everyday
60
Not everyday
3
40

20

0
Frequency Percent Valid Percent Cumulative Percent

The interviews contacted on the level of nutrition status was in terms of whether the respondent
has normal body weight, overweight or underweight as shown below.

What is the level of nutrition status

Valid Cumulative
Frequency Percent Percent Percent
Valid Normal- 18.5-24.9
32 36.8 36.8 36.8
kg/m2
Overweight- 25-29.9
11 12.6 12.6 49.4
kg/m2
Underweight- <18.5
44 50.6 50.6 100.0
kg/m2
Total 87 100.0 100.0

Most of the respondents were underweight since 50.6% where below 18.5kg/m 2 and this was
followed by those with normal body weight of 18-24.9kg/m2 with 36.8% and a small number of
them amounting to 12.6% being overweight of 25-29.9kg/m 2, the distribution of this level of
nutrition status is further shown in figure below.

xlvi
100

90

80

70

60
Normal- 18.5-24.9 kg/m2
50 Overweight- 25-29.9 kg/m2
Underweight- <18.5 kg/m2
40

30

20

10

0
Frequency Percent Valid Percent Cumulative Percent

5.0 CHAPTER FIVE

DISCUSSION OF THE FINDINGS.

xlvii
5.1 Social Economic And Demographic Factors.
5.2 Gender.

The findings of the study on factors contributing to undernutrition among adults with
tuberculosis in Kapsabet County Referral Hospital Nandi County, it's shows that among the
respondents, male had the highest percentage of 53% compared with female with 47%. This
shows that most of the men are out socializing and looking for job opportunities to earn their
living, making them at risk to get infected with tuberculosis.

5.3 Level Of Education.

The study findings shows that almost a half of the respondents where primary school leavers
with 44%, followed by those without any level of education 26%, secondary levers where 22%
and tertiary levels where 8%.Those how had primary level of education and below show a great
impact on economic status and also knowledge in prevention and control measures of
tuberculosis. This was also affecting proper dietary management of the disease as a result affect
state of their nutritional status among the respondent, resulting to undernutrition to most of them.

5.4 Marital Status.

The study shows that among the respondents 54% where married ,32% single and the rest 14%
who were widowed. The findings show that there were a higher percentage among the married
people since they live in the same house get to interact with one another compared with the
single. Despite their marital status the study also finds that most of the respondents were living in
a household of 6-10 members with a percentage of 48%. This shows that overcrowding is among
the risk factors of TB transmission and factors contributing to undernutrition within the
household because of low social economic status among the respondents.

5.5 Living Status.

The study found that most of the respondents were living in semi-permanent houses had the
largest percentage of 71 %. This shows most of the respondents live in poor living conditions
because of their low economic levels. It’s also shows that TB disease is associated mostly with
poor people, poverty is a major key, agree with(WHO).

5.6 Lifestyle Factors.

5.6.1 Alcoholism And Smoking.
The study found that most of the respondents where not drinking alcohol and smoking, fewer

xlviii
percentage where alcoholic and smokers with the percentage of 28% and 23% respectively.
Smoking and alcohol drinking are the major contributors of undernutrition in tuberculosis
disease but most of the respondents had been taught on dangers associated with alcoholism and
smoking on their regular visit to hospital, resulting in fewer percentage of this.

5.7 Nutrition Status.

The findings on nutritional status found out that undernutrition among the TB patients where
high, half of the respondents where underweight with 50%, followed by 37 % normal nutritional
status and 13% overweight. This shows that most of them are not meeting their nutritional status
due to low living standards and Tuberculosis disease associated consequences in the body that
led to increase in metabolic state of the body.

5.8 Feeding Practices.

The study findings show that over a total of 74% had their feeding routine of 2-3 number of
feeding per day, with an interval of 4-6 hours. Most of respondents includes breakfast in their
meals, some includes fruits and also vegetables in their meals. Most of the respondents were also
aware of some nutrients i.e proteins, vitamins and carbohydrates, though the information was not
coming out clearly on the nutrients function. They had been thought in the hospital although
most could not afford to eat from a variety of diet due to their low standards.

6.0 CHAPTER SIX.

CONCLUSION AND RECOMMENDATION

6.1 Conclusion.
The study found that there was a higher rate of TB the people of reproductive ages, youthful
years between18-30 and ages of 31-40 with a total percentage of 63%. TB is also high in married
people because of togetherness in the households. Overcrowding is a major factor of the spread
of the disease, most of the people live in a household of 6- 10 members within a single house.

The study also found that lack of knowledge on nutrition, low living standards, low
socioeconomic level and low education level are the major contributors of undernutrition in
tuberculosis disease. Poor lifestyle factors such smoking and alcoholism are also among the
contributors of undernutrition in tuberculosis patients attending Kapsabet County Referral

xlix
Hospital, Nandi County.

6.2 Recommendation.
The study recommends that nutrition and health education should be stared and more emphasis
to be put on the importance of good nutrition in relation to control and prevention of
undernutrition in tuberculosis and other related diseases i.e HI V/AIDs.

The study recommends all age groups should be educated on the benefits on taking a diversified,
adequate and nutritious diet to meet their nutritional needs of the body.

The study also recommends that the government should eradicate poverty by introducing income
generating activities.

l
APPENDICES 1 Work plan

Description of September October November December

task

Activity

1 Research topic

2 Chapter 1,2 and3

3 Proposal
presentation

APPENDIX 2 Budget
Items quantity Cost per unit Total cost
Fool scalps 60 @2ksh 120
Pens 3 pieces @20ksh 60
Flash disk 1 @700ksh 700
Printing A4 40 pages @10ksh 400
Binding A4 40 pages @100ksh 4000

li
Total 5280

APPENDIX 3: PERSONAL CONSENT

I am Salvine Jepleting. A student in Kenya medical training college, doing a research on factors
contributing to undernutrition among adults with tuberculosis aged 18-59 in Kapsabet County
Referral Hospital Nandi County. I am kindly requesting to help me in filling the provided
questionnaires with the necessary and required information; the exercise will be voluntary and
base on the willingness to provide information. The information will be confidential and will
keep free from an unauthorized person. Kindly tick whether you accept or not.

Accept ( ) b) Not accept ( )

Date………………………….

Signature ………………………..

Section A; Social Demographics

sex

1 Male

2 Female

age

1. 35-45

2.45-55

marital status

1.single

lii
 2.married

3.windowed

highest level of education

1.none

2. primary

3.secondary

4.tertiary

How many people live permanently in your household?

1. 0-5 years

2. 5 -15 years

3.15-49 years

What type of house do you live in?

1. permanent house

2. semi-permanent

3.homeless

Is your home adopted to your needs?

1.Yes

2.No

7a. if No do you have any problem with it? Indicate/ explain

…………………………………………………………………………..

INDIVIDUAL DIETARY KNOWLEDGE AND ATTITUDE

liii
What do you consider important as a control to control diabetes?

1. Medication

2. Diet and exercise

3. I don’t know

Maintaining a healthy weight is important in the management of tuberculosis?

1. No

2. Yes

Do you about carbohydrate as a nutrient?

1. yes
2. no

if yes do you know why it is important an important for TB patient.

Have you heard about vitamins as a nutrient?

1. Yes
2. No
If yes do you know why it is important for TB patient?
a) .
b) .
c) .

Do you know how to interpret dietary prescription?

1. Yes

2. No

If No, do you have someone at home who can do it for you?

Being drunk when suffering from tuberculosis drugs is not a serious problem.

liv
 1. Yes

2. No

FEEDING PRACTICES

How many meals do you normally take per day and at which interval?

1. Number of meals

2. Intervals (after how many hours/ minute)

Do you usually eat breakfast every day

1. Yes

2. No

lv
How many of fruits or vegetables do you eat on average per day ( unit means for example a fruit,
cup of juice, potatoes, vegetables

1. Number of units

How often do you take alcohol?

1. Never

2. 2-4 times a month

3. 2-3 times a week

4. 4 or more times a week

5. Monthly or infrequently

How many units of alcohol (beer a glass of wine or a drink do you usually drink when u take
alcohol

1. 1-2 glasses

2. 3-4 glasses

3. 5-6 glasses

4. 7-9 glasses

5. 10 or more glasses

Do you smoke?

1. Yes

2. No

What kind of fat/oil is normally used in cooking in your home

1. Oils

2. Fats

What kind of bread (bought or home- made do you usually eat?

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1. White bread

2. Whole meal bread

How often do you eat vegetables, fruits or berries

1. Everyday

2. Not everyday

SECTION D: NUTRITIONAL STATUS

HEIGHT WEIGHT BMI

Result

1. Normal

2. overweight

3. underweight

If overweight what to do to reduce weight

………………………………………………………………………………………………………
………………………………………..

………………………………………………………………………………………………………
…………………………………………

If underweight what to do to increase weight

………………………………………………………………………………………………………
……………………………………………

………………………………………………………………………………………………………

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…………………………………………….

35. If normal what to do to maintain weight

……………………………………………………………………………………

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References.

Dltd,2011: division of leprosy , tuberculosis and lung disease.

MOH 2010: guidelines for tuberculosis control

Africa health sciences, socioeconomic and demographic factors.

Centers for disease control and prevention(CDC)MMWR famine -affected refugees and
displaced populations recommendation for public health issues.july 24 1992:41:no.rr-13.

Ahmad,2013: Rajeswari et al;1999,ya et al;2006,forshorhm,et Al;2008,Ahmed et

Al;2014:Hameed et al; 2015-survey of sociodemographic prevelence ,risk factors and clinical
characteristics of TB in Nishant hospital Multan.

CDC 2019,TB and HIV co-infections.

Makerere University medical school Uganda 2014, socioeconomic factors of tuberculosis.

Nandi county health at glance,2015 precedence of tuberculosis.

Dargie,b,tesfaye, 2016, nutritional status on TB patients.

Dltdl,2011: epidemiology of tuberculosis.

CDC,2010 in,latent and active tuberculosis.

FAO,who2010 intenerant groups.

Mayo foundation for medical education and research (mfmer)1998-2019.

National TB prevalence survey 2017,TB prevalence in Kenya.

Who 2018, prevalence of TB world wide.

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