STATISTICAL ANALYSIS ON THE

CO-INFECTION OF HIV AND TUBERCULOSIS IN FEDERAL MEDICAL

CENTER ASABA

BY

FAROMBI, OLUDOTUN INAOLAJI

MATRICULATION NUMBER: 19CD026593

A PROJECT SUBMITTED TO THE DEPARTMENT OF MATHEMATICS,

COLLEGE OF SCIENCE AND TECHNOLOGY,

COVENANT UNIVERSITY OTA, OGUN STATE, NIGERIA IN PARTIAL

FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE

BACHELOR OF SCIENCE (HONOURS) DEGREE IN INDUSTRIAL

MATHEMATICS - STATISTICS

JUNE 2023
 DECLARATION

I Farombi Oludotun Inaolaji(19cd026593) declare that I worked on this project under the

supervision of Dr Oluwole A. Odetunmibi of the Department of Mathematics at Covenant

University in Ota, Ogun State, Nigeria. I ascertain that this project has not been solicited in

part or in whole for the award and recognition of any other degree elsewhere. All materials

and scholarly publications used in this work are appropriately acknowledged accordingly.

FAROMBI, Oludotun Inaolaji ________________

(Student) Signature & Date

II
 CERTIFICATION

This is to certify that the project titled "Statistical analysis on the coinfection of HIV and

tuberculosis in Federal medical center Asaba" was done by FAROMBI, Oludotun Inaolaji

(19cd026593) under the supervision of the named project supervisor and approved as having

satisfied the partial requirements for the award of Bachelor of Science Degree in Industrial

Mathematics-Statistics (BSc.) at Covenant University, Ota, Ogun State, Nigeria.

DR. OLUWOLE A. ODETUNMIBI

…………………………….

(Supervisor) Signature and Date

Prof. Samuel A. Iyase

………………………………
(Head of Department) Signature and Date

Prof. Muminu O. Adamu

………………………………

(External Examiner) signature and Date

III
 DEDICATION

I dedicate this project to my creator, my father, who sits in heaven and makes the world his

footstool for his direction and the excess grace I have gotten during this project work.

IV
 ACKNOWLEDGEMENT

I thank God, who helped me get started and accomplish my research, and my supervisor,

Dr. Oluwole Odetunmibi, for being so patient with me and my many questions. Finally, I'd

like to express my gratitude to my wonderful lecturers Dr. Adedayo Adedotun, Dr.

Okhuagbe Hilary, Dr. Abiodun Opanuga, and my dear friends; my parents, Mr. and Mrs.

Farombi; my siblings, Lola and Jimi; and everyone else who has helped me along the way.

V
 TABLE OF CONTENTS
DECLARATION....................................................................................................................II
CERTIFICATION.................................................................................................................III
DEDICATION.....................................................................................................................IV
ACKNOWLEDGEMENT........................................................................................................V
TABLE OF CONTENTS.........................................................................................................VI
ABSTRACT.........................................................................................................................IX
CHAPTER ONE....................................................................................................................1
INTRODUCTION..................................................................................................................1
1 BACKGROUND TO THE STUDY............................................................................................1
1.2 A BRIEF HISTORY AND ORIGIN OF HIV..........................................................................6
1.2.1 Overview of HIV.................................................................................................................6
1.2.2 HIV Transmission and Epidemiology...................................................................................6
1.2.3 Clinical Stages of HIV Infection...........................................................................................7
1.2.4 Acute HIV infection............................................................................................................7
1.2.5 Clinical latency (Chronic HIV infection)...............................................................................7
1.2.6 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)..........................................................8
1.3 ASSOCIATION OF HIV WITH TUBERCULOSIS (TB)...........................................................8
1.4 STATEMENT OF PROBLEM............................................................................................8
1.5 SIGNIFICANCE OF THE STUDY................................................................................................9
1.5.1 Health Impact......................................................................................................................................9
1.5.2 Epidemiological Concerns...................................................................................................................9
1.5.3 Diagnostic Challenges.......................................................................................................................10
1.5.4 Treatment and Management............................................................................................................10
1.5.5 Public Health Implications.................................................................................................................10
1.6 AIM AND OBJECTIVES.........................................................................................................11
1.6.1 AIM OF STUDY...................................................................................................................................11
1.6.2 OBJECTIVE OF STUDY........................................................................................................................11
1.7 DEFINITION OF TERMS........................................................................................................11
1.7.1 CHI-SQUARE (x2) TEST OF INDEPENDENCE........................................................................................11
1.7.2 CONTIGENCY TABLES........................................................................................................................11
1.7.3 EXPECTED VALUES.............................................................................................................................11
1.7.4 Descriptive Analysis...........................................................................................................................11
1.7.5 HIV (Human Immunodeficiency Virus)..............................................................................................12
1.7.6 Tuberculosis (TB)...............................................................................................................................12
1.7.7 HIV-TB Co-infection...........................................................................................................................12
1.7.8 Prevalence.........................................................................................................................................12
1.7.9 Risk Factors.......................................................................................................................................12
1.7.10 Treatment Outcomes......................................................................................................................12
1.8 CHAPTER SUMMARY...........................................................................................................13
CHAPTER 2.......................................................................................................................14

VI
LITERATURE REVIEW........................................................................................................14
2.1 INTRODUCTION..................................................................................................................14
CHAPTER THREE...............................................................................................................19
METHODOLOGY...............................................................................................................19
3.1 INTRODUCTION..................................................................................................................19
3.2 RESEARCH DESIGN..............................................................................................................19
3.3 POPULATION OF THE STUDY...............................................................................................19
3.4 SAMPLE AND SAMPLING TECHNIQUE..................................................................................20
3.5 RESEARCH INSTRUMENT.....................................................................................................20
3.6 RESEARCH QUESTION..................................................................................................20
3.7 HYPOTHESIS OF STUDY.......................................................................................................20
3.8 METHOD OF DATA COLLECTION..........................................................................................20
3.9 METHOD OF DATA ANALYSIS..............................................................................................21
3.10 SOFTWARE FOR DATA ANALYSIS.......................................................................................22
CHAPTER FOUR................................................................................................................23
PRESENTATION OF RESULTS AND DISCUSSION OF FINDINGS............................................23
4.1 INTRODUCTION..........................................................................................................23
4.2 PRESENTATION OF RESULTS.......................................................................................23
DESCRIPTIVE ANALYSIS ON HIV DATA:..............................................................................23
CHAPTER 5.......................................................................................................................30
SUMMARY, CONCLUSION AND RECOMMENDATION.................................................................30
5.1 SUMMARY..........................................................................................................................30
5.2 CONCLUSION......................................................................................................................31
5.3 RECOMMENDATION...........................................................................................................31
REFERENCES.....................................................................................................................32

VII
 LIST OF TABLES
Table 4.1.1 ............................................................................................................................. 23
Table 4.1.2..............................................................................................................................23
Table 4.1.3..............................................................................................................................24
Table 4.1.4..............................................................................................................................25
Table 4.2.1..............................................................................................................................26
Table 4.2.2..............................................................................................................................26
Table 4.2.3..............................................................................................................................27
Table 4.2.4..............................................................................................................................27
Table 4.3................................................................................................................................. 28

VIII
 ABSTRACT

This study investigates the association between HIV infection and tuberculosis (TB) among

patients at the Federal Medical Centre in Asaba. The analysis of data collected for this study

utilized simple percentages, frequencies an Chi-square. The results are organized according

to the research questions and hypotheses that guided the research.

IX
The findings from the gender distribution analysis, as presented the student, indicate that

among the HIV-infected patients, 38.10% were male and 61.90% were female. This suggests

a higher prevalence of HIV among females compared to males. Similarly, for tuberculosis

patients, 55.76% were male and 44.24% were female, indicating a higher incidence of

tuberculosis among males.

The study shows that HIV cases were distributed across various age groups, with the highest

frequencies observed in the 0-10 age group (30.16%) and the 31-40 age group (20.64%). In

comparison, TB cases were also distributed across age groups, with the highest frequencies in

the 21-30 age group (15.96%) and the 31-40 age group (19.80%).

The death distribution analysis, as depicted in the study, reveals that among HIV-infected

patients, 15.87% had unfortunately passed away, while 84.13% remained alive. In contrast,

among TB patients, 11.92% resulted in fatalities, while 88.08% survived. These findings

indicate a higher survival rate among HIV-infected patients and a lower mortality rate among

TB-infected patients.

The hypotheses testing, as shown in the study, utilized Pearson's Chi-squared test to examine

the relationship between HIV infection and TB. The results indicated no significant

association between HIV infection and TB (p-value = 0.1707), suggesting that individuals

with HIV are not likely to develop TB compared to those without HIV.

In conclusion, the findings from this study suggest that there is no significant association

between HIV infection and tuberculosis among the patients at the Federal Medical Centre in

Asaba. The prevalence of HIV among TB patients in this population appears to be low or

non-existent. Further research is needed to explore the general population's HIV prevalence

and its relationship to TB in this region.

X
XI
 CHAPTER ONE

INTRODUCTION
1 BACKGROUND TO THE STUDY

Statistics is a discipline of applied mathematics concerned with the gathering, description,

and analysis of data and analysis of numerical data, including the conclusions that may be

drawn from those processes. According to Hennink et al.'s research (2022), the mathematical

theories that underpin statistics are significantly dependent on the fields of differential and

integral calculus, linear algebra, and probability theory. (Hennink, et al., 2022).

People who conduct statistics, known as statisticians, are mainly interested with figuring out

how to get trustworthy deduction about big groups and general occurrences from the behavior

and other distinct features of little samples. According to MacCallum et al.'s research (2022),

these tiny samples only represent a subset of the entire population or a select number of

specific examples of an overarching pattern. (MacCallum, et al., 2022).

Even after Ninety years of vaccinations and Sixty years of chemotherapy, tuberculosis (TB)

is still the largest cause of death from a medium of infection in the world, surpassing human

immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) for the first

time (WHO 2015b, 2016a). This is despite the fact that TB has been treated for the past 60

years. According to estimates provided by the World Health Organization (WHO),

tuberculosis (TB) is accountable for around Ten million eight hundred thousand new cases

and one million eight hundred thousand deaths per year. The health system is unaware of

around 3 million of these newly diagnosed cases, which means that many of these patients are

not receiving the appropriate therapy.

Mycobacterium tuberculosis (Mtb) is the causative agent of TB, an infectious bacterial illness

that is transferred from human to human via the respiratory system. Although tuberculosis

most frequently affects the lungs, it has the ability of wreaking havoc on any tissue. Emery et

1
al. 2021 found that only around ten percent of those who were ill with Mtb will have active

TB illness over their life span. This means that the majority of people who become infected

will be able to successfully limit their infection. It is difficult to treat tuberculosis because the

illness's causative agent can remain dormant in the bodies of many infected individuals for a

considerable amount of time before becoming active again and causing sickness. Infection

with tuberculosis carries a significant chance of developing into tuberculosis illness; this risk

is at its maximum shortly after the initial infection, and it is drastically increased in those who

are also co-infected with HIV/AIDS or other immune-compromising disorders. ( Emery, et

al., 2021).

The treatment of tuberculosis illness warrants the use of many medications over the course of

months. Long pharmacological treatments provide difficulties for patients as well as for the

healthcare systems that treat them. This is especially true in low and middle-income countries

(LMICs), where the illness burden occassionally considerably exceeds the resources available

in the community. There are certain regions that are seeing an increase in the prevalence of

drug-resistant tuberculosis, which necessitates treatment regimens that are even longer and

require medications that are both more difficult to stomach and more expensive. (Jain, et

al.,2020)

However, smear microscopy is only competent of identifying between fifty and sixty percent

of all cases (smear-positive) in low- and middle-income countries (LMICs). The primary

method of diagnosis in these countries is the microscopic analysis of coloured smears of

probable patients' sputum.Recently, more perceptive ways of pinpointing tuberculosis and

identifying resistance to medications have been available. These procedures, however, cost

more than their predecessors. The time that elapses from the beginning of an illness and the

point at which a diagnosis is established and treatment is begun is frequently drawn out. This

prolongation of time allows for the spread of disease. Although bacille Calmette–Guérin

2
(BCG) is still the most widely used vaccination in the world, the effectiveness of the vaccine

is very varied depending on location and is only partially effective. The modeling implies that

more effective vaccinations would likely be required in high-incidence environments in order

to drive progress toward eliminating TB.

Since the beginning of the fight against tuberculosis (TB), the primary tactic has been to

administer diagnostic and treatment to patients who present themselves at medical facilities

reporting symptoms consistent with the disease. The basis of this argument is that if patients

who are now afflicted with the illness are healed, then death will stop occurring, illness

incidence rates will decrease, transmission will go down, and hence, incidence should go

down as well. The truth on the ground in many nations is more nuanced, and the overall rate

of incidence reduction has been inexcusably sluggish, averaging just approximately 1.5

percent each year.

One of the health therapies that offers the most value for the money is chemotherapy for

tuberculosis. (McKee, et al., 2006). Evidence such as this has been essential in getting the

World Health Organization's (WHO) and the Stop TB Partnership's (STOP TB) directly

observed treatment, short course (DOTS) plan adopted worldwide (UN General Assembly,

2000). Direct observation of therapy (DOT), in which a health care provider sees the patient

taking the drug physically, may be a part of, but is significantly larger than, the DOTS

approach to curb TB (WHO 2013a).

Over the past few decades, TB has been largely contained thanks to these efforts and the

backing of governments throughout the world. The number of deaths attributed to

tuberculosis worldwide decreased from 1.47 million in 1990 to 1.20 million in 2010. From

2000 and 2015, it increased by 22% (WHO, 2016a) (Cornea, 2019). WHO (2016)a estimated

that 50 million lives will be spared by the year 2015. The international targets for TB, as

enshrined in the United Nations (UN) Millennium Development Goals (MDGs), sought "to

3
stop and reverse the increasing incidence of tuberculosis by 2015," and this objective was

partially met in all six WHO regions and in the majority, but not all, of the world's 22 high-

burden countries (WHO 2014c).

There have been improvements, yet significant gaps persist. Although the Sustainable

Development Goals (SDGs) seek to end the TB pandemic completely, the decline in

incidence has not been adequate so far (WHO 2015a, 2015c). In the highest incidence

nations, case identification and treatment success rates remain inadequate; one in three people

with TB are still "unknown to the health system," and many more are misdiagnosed and go

untreated. Resistance to many anti-TB medications, including isoniazid and rifampin, is on

the rise worldwide (WHO 2011a). The prevalence of tuberculosis strains that are resistant to

all available drugs, known as extensively drug-resistant (XDR) TB, has also increased. These

cases are almost often now attributed to transmission rather than inadequate treatment. The

findings of Rio and co-workers' (2021) study (Rio, et al., 2021).

If stopping the spread of an infection is the goal of control, then tuberculosis can only be

stopped if new cases are found quickly, treatment is started and continued without fail, and

latent TB is cured or prevented. New methods and more effective instruments and treatments

are needed to accomplish post-2015 targets (Bloom et al., 2016). These treatments need to

not only be cheap, but also have a significant global impact.

There are three key innovations that must be made in order to bring tuberculosis under

control: improved point-of-care diagnostics, improved treatment regimens for both drug-

receptive and drug-resistant TB, and improved immunizations. This necessitates the creation

of novel approaches and resources, such as replacing passive case finding with active case

finding in high-burden areas, delivering services to the most exposed populations, integrating

these services with others, especially HIV/AIDS services, and providing basic health care and

4
community-based care. especially, in countries where TB is common, many people who are

infected do not show any symptoms.

Therefore, the transmission and incidence rates have not been adequately reduced by waiting

for individuals to get unwell enough to seek treatment. (Olabiyi, et al., 2021). It is necessary

to take a strategy that is more proactive and aggressive in order to combat the hurdles that

exist within the health system in order to effectively manage tuberculosis.

Over the course of time, the approaches to tuberculosis control that are recommended by the

WHO have undergone substantial development. In its early iterations, the primary principles

of the global TB control plan were clinical and programmatic in character, focused mostly on

the distribution of standardized treatment regimens; the underlying idea was that the problem

could be managed in great part by already available biomedical instruments. However, in

many low- and middle-income countries (LMICs), the inadequacies of the health systems,

funding, health workforce, attainment and supply chain management, and information

systems have hampered attempts to control tuberculosis and have not been fully addressed by

those efforts.

1.2 A BRIEF HISTORY AND ORIGIN OF HIV

Human Immunodeficiency Virus (HIV) is a viral infection that primarily affects the immune

system, leading to progressive immune dysfunction and leaving individuals susceptible to

opportunistic infections and diseases. Since its emergence in the early 1980s, HIV has

become a global public health concern, with significant impacts on individuals, communities,

and healthcare systems worldwide. Understanding the background and characteristics of HIV

5
is essential for studying its association with tuberculosis (TB) and developing effective

prevention and treatment strategies. (Armstrong, et al., 2014)

1.2.1 Overview of HIV

HIV is a retrovirus belonging to the family of Lentiviruses. It is primarily transferred through

contact with certain body fluids, including blood, semen, vaginal fluids, and breast milk. The

virus primarily targets CD4+ T cells, a key component of the immune system responsible for

coordinating immune responses. HIV uses CD4 receptors to enter these cells, leading to their

depletion and functional impairment.

1.2.2 HIV Transmission and Epidemiology

HIV can be passed through various routes, including unprotected sexual intercourse (both

heterosexual and homosexual), sharing contaminated needles or syringes among people who

inject drugs, mother-to-child transmission during pregnancy, childbirth, or breastfeeding, and

rarely, through blood transfusion or organ transplantation from an infected donor. However,

effective prevention strategies have significantly reduced HIV transmission rates. These

include consistent condom use, access to clean needles and syringes, blood screening for

HIV, ART, and PMTCT programs. The global epidemiology of HIV varies across regions

and populations. Sub-Saharan Africa remains the most heavily affected region, accounting

for the majority of new HIV infections, followed by Asia, Latin America, and Eastern

Europe. Key populations at higher risk of HIV males who have intercourse with other men,

people who inject drugs, sex workers, transgender persons, priapic women, and sex

offenders.

1.2.3 Clinical Stages of HIV Infection

6
HIV infection progresses through several clinical stages, characterized by different levels of

immune function and clinical manifestations. These stages include:

1.2.4 Acute HIV infection

Shortly after initial infection, individuals may experience flu-like symptoms such as fever,

fatigue, swollen lymph nodes, and rash. This stage is known as acute retroviral syndrome.

During this stage, the virus replicates rapidly, and individuals are highly infectious.

1.2.5 Clinical latency (Chronic HIV infection)

This stage is often asymptomatic or minimally symptomatic. HIV replication continues at

lower levels, but the immune system maintains a balance. Without treatment, this stage can

last for several years.

1.2.6 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

In the absence of treatment, HIV infection progresses to AIDS, characterized by severe

immune deficiency. Individuals with AIDS are highly susceptible to opportunistic infections,

certain cancers, and other complications. The diagnosis of AIDS is based on specific clinical

criteria and a CD4+ T cell count below a certain threshold.

1.3 ASSOCIATION OF HIV WITH TUBERCULOSIS (TB)

HIV infection profoundly affects the risk and clinical presentation of TB, a bacterial infection

caused as a result of Mycobacterium tuberculosis. HIV makes the immune system weak,

making individuals more receptive to TB infection, as well as advancing the risk of TB

reactivation in those with latent TB infection. Conversely, TB can accelerate the progression

of HIV infection and increase the risk of mortality in HIV-positive individuals.

7
The interaction between HIV and TB has led to a complex co-epidemic, particularly in high-

burden settings. The high prevalence of HIV among TB patients and vice versa complicates

TB control efforts. Studying the association between.

1.4 STATEMENT OF PROBLEM

A major problem that this project is looking to solve is to help understand if there is an

association between tuberculosis and HIV. However, the co-occurrence of HIV infection and

tuberculosis poses a significant public health challenge worldwide. The interaction between

these two diseases has been observed to have a profound impact on disease progression,

clinical manifestations, treatment outcomes, and overall burden on healthcare systems.

However, there are several gaps in our understanding of the specific mechanisms underlying

the association between HIV and TB, as well as the optimal strategies for prevention,

diagnosis, and management in individuals with both conditions. Addressing these gaps is

crucial for developing effective interventions and policies that can effectively reduce the dual

burden of HIV and TB and improve patient outcomes.

Statistical analysis will be decisive in finding out if there is an association between these

diseases.

1.5 SIGNIFICANCE OF THE STUDY

The coexistence of human immunodeficiency virus (HIV) and tuberculosis (TB) has become

a significant public health concern worldwide. The HIV pandemic has had a huge impact on

the global TB burden, with a substantial increase in TB cases and death among individuals

living with HIV. Understanding the relationship between HIV and TB is crucial for effective

prevention, diagnosis, and management of these two diseases. This study aims to investigate

8
the significance of the association between HIV and tuberculosis and its implications for

public health.

1.5.1 Health Impact

The union between HIV and TB has a significant health impact on individuals and

populations. HIV reduces the strength the immune system, making persons more receptive to

TB infection. Co-infected individuals often experience more severe and atypical forms of TB,

leading to increased morbidity and mortality. Understanding the impact of this association

can guide healthcare providers in implementing appropriate interventions and improving

outcomes for affected individuals.

1.5.2 Epidemiological Concerns

The HIV-TB co-epidemic poses considerable challenges for epidemiological control. TB is

the major cause of death among people with HIV, particularly in resource-limited settings.

World Health Organization (2022) The high prevalence of HIV between TB patients and vice

versa complicates TB control efforts. Studying the association can provide valuable insights

into the dynamics of the co-epidemic, aiding in the growth of targeted prevention and

treatment strategies. World Health Organization (2020)

1.5.3 Diagnostic Challenges

The presence of HIV can complicate the diagnosis of TB, as it can affect the accuracy of

conventional diagnostic tests. HIV-induced immunosuppression can result in false-negative

results or atypical clinical presentations, leading to delays in diagnosis and treatment

initiation.

9
1.5.4 Treatment and Management
Co-management of HIV and TB is crucial for optimal patient outcomes. The presence of

HIV can complicate TB treatment due to drug interactions, potential adverse effects, and

challenges with treatment adherence. Moreover, the occurrence of immune reconstitution

inflammatory syndrome (IRIS) during antiretroviral therapy initiation in co-infected

individuals requires special attention. Understanding the association can guide healthcare

providers in developing integrated treatment strategies that address the unique needs of co-

infected individuals.

1.5.5 Public Health Implications

The association between HIV and TB has broader public health implications. The global

burden of HIV-TB co-infection contributes significantly to healthcare costs, socioeconomic

disparities, and healthcare system strain. Effective control and management of the co-

epidemic require a multidimensional approach that includes HIV prevention, TB control, and

strengthened healthcare systems. This study's findings can inform policymakers and public

health officials in resource allocation, program development, and implementation of

interventions to mitigate the impact of HIV-TB co-infection.

1.6 AIM AND OBJECTIVES

1.6.1 AIM OF STUDY

The aim of this study is to investigate and understand the association between HIV and

tuberculosis (TB) using Federal Medical Centre, Asaba as a case study.

1.6.2 OBJECTIVE OF STUDY

1) Investigate the relationship or association between HIV and tuberculosis.

2) Ascertain if the relationship is significant or not.

10
3) Investigate the pattern with respect to age and gender using descriptive analysis.
4) Investigate the which of the diseases has a higher death rate.
5) Investigate the independence of the coinfection of HIV and tuberculosis.

1.7 DEFINITION OF TERMS

1.7.1 CHI-SQUARE (x2) TEST OF INDEPENDENCE
In order to establish whether or not two categorical variables are connected to one another, a

test known as the chi-square test of independence is carried out. If the variables are found to

be related, then the probability of one variable having a specific value is determined by the

value of the other variable.

1.7.2 CONTIGENCY TABLES

When performing a chi-square test of independence, the most efficient way to arrange your

data is a type of frequency distribution table called a contingency table.

1.7.3 EXPECTED VALUES

The observed frequencies are contrasted with the frequencies that were

predicted as part of the chi-square test of independence. The proportions of one

variable will remain the same for all possible values of the other variable if the

predicted frequencies are calculated correctly. Utilizing the contingency table,

you are able to arrive at an estimate of the predicted frequencies.

1.7.4 Descriptive Analysis

This is a statistical technique used to describe the major features of a dataset. It involves

organizing, displaying, and analyzing data to provide a clear and concise overview of the

variables under consideration. The descriptive analysis focuses on describing the

characteristics and patterns within the data without making any inferences or generalizations

to a larger population.

11
1.7.5 HIV (Human Immunodeficiency Virus)
HIV is a retrovirus that ambushes the immune system, most importantly the CD4 cells (T

cells), which play a crucial role in fighting off infections. HIV wears out the immune system

over time, making individuals more vulnerable to various opportunistic infections, including

TB.

1.7.6 Tuberculosis (TB)

TB is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It majorly

affects the lungs but can also target other parts of the body. TB is spread through the air when

an infected individual coughs, sneezes, or talks, and it can be severe if left unattended.

1.7.7 HIV-TB Co-infection

HIV-TB co-infection refers to the simultaneous presence of both HIV and TB infections in an

individual. When a person is co-infected, HIV and TB interact synergistically, leading to

increased morbidity and mortality rates compared to individuals with either infection alone.

1.7.8 Prevalence
Prevalence refers to the proportion of a population that has a specific condition or disease at a

given point in time. In the context of the association between HIV and TB, prevalence would

describe the number of individuals who have both HIV and TB infections within a specific

population.

1.7.9 Risk Factors

Risk factors are characteristics that escalate the likelihood of a person acquiring a particular

disease or condition. In the case of HIV-TB co-infection, risk factors may include factors

such as unavailability to healthcare, poor immune function, and behaviors that increase the

risk of contracting HIV or TB.

1.7.10 Treatment Outcomes

Treatment outcomes refer to the results or effects of interventions or therapies provided to

individuals with HIV and/or TB. In the context of co-infection, treatment outcomes would

12
involve assessing the effectiveness of treatment regimens for both HIV and TB, as well as

monitoring the impact of co-infection on treatment response and overall health outcomes.

1.8 CHAPTER SUMMARY

The significance of studying the association between HIV and TB lies in its profound health

impact, epidemiological concerns, diagnostic challenges, treatment and management

complexities, and wider public health implications. The result of this study can assist the

growth of evidence-based strategies to prevent new infections, improve diagnostic accuracy,

optimize treatment outcomes, and decrease the burden of HIV-TB co-infection on individuals

and populations. By addressing this critical research gap, we can move closer to achieving the

goal of eliminating HIV and TB as global health concern.

CHAPTER 2

LITERATURE REVIEW
2.1 INTRODUCTION

An investigation of the International HIV/AIDS Workplace Education Program (IHWEP).

Goss and Adam-Smith are credited with carrying out the research in 2004. In the course of

their research, the researchers from SHARE (Strategic HIV/AIDS Responses by Enterprises)

in Barbados examined the International HIV/AIDS Workplace Education Program. The

approach for the evaluation includes a study of the relevant documents, individual interviews

with key informants, site visits, and focus groups comprised of workers from participating

firms. The findings of the study showed that the ILO/USDOL HIV/AIDS Workplace

Education Project in Barbados generated favorable effects that are still largely unknown in

the nation. The research was carried out in Barbados. The approach that the Project used was

suitable for Barbados, and it successfully incorporated all of the most important players. The

Project was beneficial to the partnership of the three parties. The NPC is responsible for the

13
extremely professional manner in which project operations were carried out. The Project

pioneered the use of alternative methods to convey BCC messages, including as "ambush"

theatre and cooperation with the media. As a direct result of their participation in the Project,

a number of the participating businesses developed highly effective programs for community

engagement. (Goss & Adam-Smith, 2004).

An investigation of the rate of HIV infection experienced by TB patients in Benadir, Somalia.

The purpose of the research was to obtain the proportion of TB patients in Benadir, Somalia

who were HIV positive. The research was carried out in the year 2002. IBM SPSS Statistics

version 20 was utilized throughout the process of doing the data analysis. The confidence

limits of the P-value were used to determine the incidence of HIV infection among

tuberculosis patients. The threshold for importance was set at 0.05. In total, 3061 tuberculosis

patients whose HIV status was known were considered for inclusion in the study. However,

79 of the cases lacked necessary data, 14 of the patients had been transferred from other TB

centers located outside of Benadir Province without any documentation of their HIV status,

and 11 of the patients had HIV tests that were not available. These groups were not

considered for inclusion in this study because it was carried out in Bendir, which is located in

the country of Somalia. According to the findings of the study, there were only 46 patients

(1.5% of the total) who were infected with HIV and tuberculosis simultaneously, while the

remaining 3015 patients (98.5%) were HIV-negative cases. Male TB patients made up 64.7%

of the total participants in the research, whereas there were only 35.3% female TB patients.

There were 46 HIV-positive patients, 29 of them were male (63 percent), whereas only 17 of

them were female (37 percent), although this difference was not statistically significant.

Young adults and children accounted for the vast majority (73.4% of all TB cases).

(Abdirahman Mohamed Hassan Dirie, 2002).

14
A study on the relationship between HIV and TB of the lungs was conducted at the chest

clinic of a general hospital in Lagos, Nigeria. The experiment was conducted at a chest clinic

in Lagos, Nigeria, to discover whether or not there is a link between HIV and pulmonary

tuberculosis. A cross-sectional study, the retrieval of population statistics from the TB patient

register, HIV testing using rapid testing and confirmation by the hospital laboratory, the use

of descriptive statistics to obtain information about study participants, bivariate analysis for

estimation of odds ratio (OR) and 95% confidence interval (CI), and the use of chi-square to

determine the relationships between study variables are all part of the methodology. The

findings revealed that one hundred and Thirty patients agreed to be tested for HIV; 88

patients were male, accounting for 67.7% of the patients; 85.4% of the patients had sputum

smear positive TB, while the remaining patients were sputum smear negative; 15.4% of the

patients had HIV; HIV prevalence among male patients was 13.6%, but 19.1% among female

patients; HIV prevalence among sputum smear positive TB

(Famuyiwa, 2015).

A study on HIV associated tuberculosis, the objective was to investigate the diagnosis and

treatment of HIV associated tuberculosis. It was done in 2021, The findings include: Several

recommended therapy regimens exist for the treatment of HIV/AIDS, tuberculosis, and

coexistent infections. The first-line treatment regimen for HIV/AIDS begins with opting for a

nucleoside reverse transcriptase inhibitor. TB treatment begins with opting for the standard

four-drug regimen (Isoniazid, Ethambutol, Rifampicin, Pyrazinamide) for two months and

later on alternating it with two (Isoniazid and Rifampicin) for the next four months. The

treatment is highly selective and varies from patient features to patient features, along with

their intensity.

(Akkad, 2021).

15
A study on cross border migration and the spread of infectious diseases (HIV & TB), A study

on the correlation between cross-border migration and the spread of HIV and tuberculosis,

The research was done in 2021 by Ethel, it was done in Nigeria and Benin Republic. The

following were the findings:

- For males in Nigeria and Benin Republic, cross-border migration does not contribute to the

transmission of HIV.

- For females in Nigeria and Benin Republic, there is a positive relationship between cross-

border migration and HIV prevalence, suggesting that cross-border migration contributes to

the advancement of HIV among female in these countries.

- In Benin Republic, there is a moderate positive association between cross-border migration

and tuberculosis incidence, indicating cross-border migration contributes to the incidence of

tuberculosis in the country.

- No correlation result was found for Nigeria due to the constant nature of the data.

(Ethel, 2021).

A study on the evolution of the mechanism for anticipating the results of HIV/TB co-

infection in convicts, A study on the development of a forecasting information system for the

outcome of HIV and tuberculosis coinfection in felons using mathematical modeling and

machine learning methods. The study was done by S B Ponomarev in 2019, The following

were the findings;

- The proposed forecasting information system for the TB/HIV co-infection outcome

improves the quality of healthcare for patients with HIV-associated tuberculosis.

- The system helps in timely correction of treatment, prophylactic and organizational

measures, reducing mortality from the disease.

16
- The method is simple, convenient, fast, and has minimum cost.

- The proposed method can be used as a screening test.

(S B Ponomarev, 2019).

A study on the Long-term pulmonary damage in patients living with HIV and TB is predicted

by pulmonary restriction, this study was conducted in 2021, The research aimed to find the

connection between clinical covariates and long-term pulmonary impairment in people with

HIV and tuberculosis. The study involved 134 participants with a middle age of 36, all of

whom reported Black African race. The participants were analyzed using bivariate analyses

and logistic regression to determine the association between participant characteristics and

impaired lung function at baseline and at 12 months. The study was conducted in South

Africa, The study found that When a person has HIV or TB, pulmonary limitation is an

indicator of future pulmonary impairment. The analyses were conducted in SAS version 9.4

and R version 3.6.0. (Sara C. Auld, 2021).

17
 CHAPTER THREE

METHODOLOGY
3.1 INTRODUCTION
This chapter dealt with the description of the procedure that was used in carrying out this

study. It covered the following:

 plan of the Study

 Participants in the Study

 Sample and Sampling method

 Research Instrument

 Research Question

 Hypothesis of study

 Method of collecting data

 The Method of Analyzing the Data

 The Software for Analyzing the Data

3.2 RESEARCH DESIGN

The research made use of the the descriptive survey research design. This design permits the

description of variables as they exist in their natural settings. This approach made it easier to

gather information that could be used to describe and make sense of pre-existing situations

18
and customs. using a representative sample of the population. This design was found

acceptable for this study, because it was primarily meant to describe the association of HIV to

tuberculosis.

3.3 POPULATION OF THE STUDY

The population of the research consisted of patients with HIV and TB. The data used in this

study was collected from the Federal Medical Centre, Asaba. The survey is developed to

collect data on HIV and TB. The survey was pilot tested using the number of patients who

has been examined within the period of 10 years at Federal Medical Centre, Asaba.

3.4 SAMPLE AND SAMPLING TECHNIQUE

Given the size of the population, the total population was used as the sample size. Hence,

census sampling was used.

3.5 RESEARCH INSTRUMENT

The tool for data collection for this research was done using the EMR (Electronic Medical

Records).

3.6 RESEARCH QUESTION

is there an association between HIV and tuberculosis (TB)?

3.7 HYPOTHESIS OF STUDY

H1: There is a significant relationship between HIV infection and tuberculosis, indicating that

individuals with HIV are more prone to develop TB compared to those without HIV.

H0: There is no significant association between HIV infection and tuberculosis, indicating

that individuals with HIV are not likely to develop TB in comparison to those without HIV.

19
3.8 METHOD OF DATA COLLECTION

The hospital gave its permission for us to use their electronic medical records (EMR) to

collect data, and we did so with their full cooperation. The device was controlled by the

researcher with the assistance of an IT professional to whom the researcher had constant

access throughout the data collection process; the researcher therefore received firsthand

knowledge of data extraction and cleansing. The data was coded and inputed into a database

for future reference.

3.9 METHOD OF DATA ANALYSIS

The data collected were analyzed using descriptive analysis and chi-square analysis.

descriptive analysis is a statistical method used to summarize and explain the main features

of a dataset. There are several techniques and tools commonly used in descriptive analysis,

including measures of central tendency, measures of dispersion, graphical representations,

and summary statistics while Chi-square analysis is a statistical test used to decide if there is

a significant association between two categorical variables. These statistical methods were

used to answer the research questions.

X2 ¿ ¿ ¿

with K-1 degree of freedom.

Where; X2 = The chi-square test statistic

K = represents the number of categories

O = represents an observed frequency in certain category;

E = represents an expected frequency in a particular category.

20
If you have two categorical variables, you may use chi-square analysis to see if there is a

statistically significant relationship between them. The chi-square test's null hypothesis

assumes no correlation between the variables, whereas the alternative hypothesis assumes a

correlation exist. Before conducting the chi-square analysis, the assumptions for the test will

be checked. The assumptions include:

1. The variables are categorical and measured at a nominal or ordinal level.

2. The observations are independent.

3. The expected cell counts are greater than or equal to 5 for each cell, and no greater

than 20% of the cells have expected counts less than 5.

If the hypotheses are satisfied, the chi-square test will be performed. The chi-square statistic,

the number of degrees of freedom, and the p-value will have been computed. The chi-square

statistic measures the difference between the observed and expected frequencies of each

category, whereas the degrees of freedom are the product of the number of categories in each

variable minus 1. Assuming that the null hypothesis is true, the p-value is the probability of

obtaining a chi-square statistic comparable to, or even more intense than, the observed

statistic.

3.10 SOFTWARE FOR DATA ANALYSIS

The software used in this analysis is the R software. R is a widely used programming

language and software for statistical analysis, data visualization, and data manipulation. It

gives a vast collection of packages and libraries that help researchers, data scientists, and

statisticians to conduct a wide range of data analysis tasks efficiently. Overall, R is a versatile

and flexible software environment for data analysis, providing a thorough set of tools and

packages for statistical analysis, data manipulation, and visualization. Its popularity in the

21
data science community, extensive package ecosystem, and focus on reproducibility make it a

preferred choice for many researchers and analysts.

CHAPTER FOUR

PRESENTATION OF RESULTS AND DISCUSSION OF FINDINGS

4.1 INTRODUCTION
This chapter dealt with the presentation of results and discussion of the results. The results of

the analysis are displayed in the order of the research questions and hypotheses that ushered

the research.

4.2 PRESENTATION OF RESULTS

DESCRIPTIVE ANALYSIS ON HIV DATA:

Table 4.1.1 Gender of HIV patients

Gender Frequency Percentage

Male 24 38.10

Female 39 61.90

Total 63 100.00

The above data shows that 24 (38.10%) of the patients infected with HIV are male while 39

(61.90%) of the patients infected with HIV are female. From the above data we can see that

the female gender have a higher case of HIV than the male gender.

22
 Table 4.1.2 Age interval of HIV patients

Age Frequency Percentage

Interval
0-10 19 30.16

11-20 4 6.35

21-30 2 3.17

31-40 13 20.64

41- 50 12 19.05

51-60 10 15.87

61 - 70 3 4.76

Total 63 100.00

This data suggests that among those who tested positive for HIV, 19 were children under

the age of 10, 4 were adolescents, 2 were young adults (aged 21-30), 13 were middle-aged

(aged 31-39), and 12 were middle-aged (aged 31-49) or older (aged 41-50). The foregoing

statistics make it very evident that the incidence of HIV is highest among children and young

adults.

23
 Table 4.1.3 Death rate of HIV patients

Death Frequency Percentage

Dead 10 15.87

Alive 53 84.13

Total 63 100.00

The above data shows that 10(15.87%) of the patients infected with HIV died while

53(84.13%) of the patients infected with HIV are alive. From the data above we can see that

the number of patients that died are fewer than the number of patients that are alive.

24
 Table 1.1.4 Days Interval Of HIV Patients

Days
Frequency Percentage
Interval
1-20 38 64.41

21-40 12 20.34

41-60 2 3.39

61-80 3 5.08

81-100 1 1.69

Above 3 5.08
100

Total 59 100.00

According to the data provided above, 38 (64.41%) of HIV-infected patients were

hospitalized for a total of 1-20 days, 12 (20.34%) were hospitalized for a total of 21-40 days,

2 (3.39%) were hospitalized for a total of 41-60 days, and 3 (5.08%) were hospitalized for a

total of 61-80 days. According to the aforementioned data, most people living with HIV

spent between one and twenty days in the hospital.

25
DESCRIPTIVE ANALYSIS ON TUBERCULOSIS DATA

Table 4.2.1 Gender of tuberculosis patients

Gender Frequency Percentage

Male 276 55.76

Female 219 44.24

Total 495 100.00

The above data shows that 276 (55.76%) of the patients infected with tuberculosis are male

while 219(44.24%) of the patients infected with tuberculosis are female. The above data

clearly shows that the male gender have higher cases of tuberculosis than the female gender.

Table 4.2.2 Age Interval of Tuberculosis Patients

Age
Frequency Percentage
Interval
0-20 116 23.43

21-40 177 35.76

41- 60 133 26.87

61-80 59 11.92

81-100 10 2.02

Total 495 100.00

From the data provided, we can infer that 25.87% of tuberculosis patients were under the age

of 20, 35.76% were between the ages of 21 and 40, 26.67% were in the interval of 41 and 60

years in age, 11.92% were between the ages of 61 and 80, and 2.25% were over the age of 80.

Those between the ages of 21 and 40 have the highest TB prevalence rates.

26
 Table 4.2.3 Death Rate of Tuberculosis Patients

Death Frequency Percentage

Dead 59 11.92

Alive 436 88.08

Total 495 100.00

The above data shows that 59(11.92%) of the patients infected with tuberculosis died while

436(88.08%) of the patients infected with tuberculosis are alive. The above data reveals that

the number of patients that died from tuberculosis are fewer than the number of patients that

are alive.

Table 4.2.4 Days Interval for Tuberculosis Patients

Days
Frequency Percentage
Interval
1-20 312 63.03

21-40 126 25.45

41-60 32 6.46

61-80 11 2.22

81-100 5 1.01

Above 100 9 1.82

Total 495 100.00

27
The above data reveals that 312(63.03%) of the patients infected with tuberculosis spent

between 1-20 days in the hospital, 126(25.45%) of the patients infected with tuberculosis

spent between 21-40 days in the hospital, 32(6.46%) of the patients infected with

tuberculosis spent between 41-60 days in the hospital, 11(2.22%) of the patients infected

with tuberculosis spent between 61-80 days in the hospital, 5(1.01%) of the patients

infected with tuberculosis spent between 81-100 days in the hospital and 9(1.82%) of

patients infected with tuberculosis spent above 100 days in the hospital. From the above

data it is clear that a majority of the patients infected with tuberculosis spent between 1-20

days in the hospital.

Table 4.3 CHI-SQUARE ANALYSIS

X2
df p-value
value
Pearson Chi-Square 51.692 43 0.1707

The table above shows the result obtained after using R-software to carry out the chi-square

analysis on the association between HIV and tuberculosis using gender and age as the

variables of interests.

Hypothesis:

H1: There is a significant relationship between HIV infection and tuberculosis, indicating that

individuals with HIV are more likely to develop TB in comparison to those without HIV.

H0: There is no significant association between HIV infection and tuberculosis, indicating

that individuals with HIV are not likely to develop TB in comparison to those without HIV.

28
Decision:

Based on the findings of the Pearson's Chi-squared test, we cannot reject the null hypothesis

because the p-value of 0.1707 us greater than the significance threshold of 0.05.

Conclusion:

There is no significant association between HIV and tuberculosis, which indicates that

individuals with HIV are not likely to develop TB compared to those without HIV.

29
 CHAPTER 5
SUMMARY, CONCLUSION AND RECOMMENDATION

5.1 SUMMARY

This research used primary data and statistical analysis to therefore determine if there is an

association between Human Immunodeficiency Virus and Tuberculosis using the Federal

medical center, Asaba as a case study. This research consists of five chapters. The first

chapter covered the background of the research, it talked about the respective diseases and

some terms associated with them. The second chapter covered a review of a number of

research papers. The third focused on the methodology used for the analysis, Population of

the study, sample and sampling technique, Hypothesis of study, method of data analysis,

software for data analysis, etc. The fourth chapter covered the analysis of the data using chi-

square analysis and the descriptive analysis of the data used the decision, and the conclusion.

Chapter 5 consists of a summary of result, conclusion, and a recommendation.

5.2 CONCLUSION

This study focused on investigating the relationship between Human Immunodeficiency

Virus (HIV) and tuberculosis, as well as their co-infection. The main objective was to assess

the potential association between these two diseases utilizing the Chi-square analysis. The

analysis was conducted using R Studio software, and based on the findings, a decision and

conclusion were drawn.

5.3 RECOMMENDATION

1. Implementation of an awareness program: It is recommended to establish

an awareness program aimed at educating the public about the consequences

of HIV and tuberculosis, as well as effective preventive measures to avoid

30
 contracting these diseases. This program can help raise awareness, dispel

myths, and promote healthier behaviors in the community.

2. Provision of free tuberculosis vaccinations: In order to curb the rise in

tuberculosis cases, it is advisable for the government or non-governmental

organizations (NGOs) to provide free tuberculosis vaccinations, especially to

infants. By offering accessible and cost-free vaccinations, the aim is to prevent

the occurrence and transmission of the disease among vulnerable populations.

These recommendations are intended to contribute towards disease prevention, education,

and improved public health outcomes in relation to HIV and tuberculosis.

31
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