Sleeping with Tuberculosis: Do over-crowded university hostels in Kenya increase TB transmission among youths - A pilot study

Abstract Background Understanding the magnitude of Tuberculosis (TB) transmission among the youth is a global priority as the disease burden shifts to this population. Learning institutions host overcrowded accommodation and classrooms, especially in resource limited contexts. Understanding the global threat of the youth as an infection pool on the wider population is highlighted in the global response to COVID 19. This pilot study aimed to test the feasibility of recruiting university students’ contacts and demonstrate transmission of TB in Pwani University, Kilifi County-Kenya. Materials and Methods A pilot study among Pwani University TB index cases receiving treatment at the Kilifi County Hospital was conducted. Index cases who consented provided information about their household and social contacts. Contacts were identified and screened using a World Health Organization (WHO) symptom-based questionnaire. Their sputum samples were analysed using GeneXpert. Multivariate log-binomial regression was used to determine demographic and clinical characteristics associated with TB infection among contacts with TB index patients. Results A total of 51 index cases were recruited, median (IQR) age of 21 (20–23) years and 31 (61%) were males. 156 contacts were screened, median (IQR) age of 23 (20–23) years, 80 (51%) were males and 76 (49%) were household contacts. Among the 156 TB contacts, 5 participants were confirmed positive for TB: prevalence of 3.2% (95% CI 1.0 to 7.3%). 8/156 (5.1%, (95% CI 2.2 to 10%) contacts, had clinical diagnosed TB despite having a negative GeneXpert result. In total 13/156 contacts had either confirmed or clinical diagnosed TB; 8.3% (95% CI 4.5 to 14%). Sharing a bed with an index case was the only factor significantly associated with TB infection among the five contacts with GeneXpert diagnosed TB. Conclusion Students sleeping in crowded hostels promote TB transmission within universities informing TB control interventions. Collaborating with existing national TB programme systems is a feasible approach to recruit people with active disease and their social contacts. Expansion of this approach to a larger population of students with TB infection may demonstrate the magnitude of TB transmission within universities, and the wider local communities.