105 4 Diabetes-tuberculosis comorbidity in a low-income setting does not negate their relevance in planning and implementing early TB case finding and treatment activities, as sample size, facility sampling procedure, and patient enrolment may have impacted our results. Strength and Limitation This study is the first to report on the prevalence of elevated blood glucose among TB patients in Eswatini, a country with a high HIV prevalence. We sampled health facilities from the four regions of Eswatini, so our findings are representative; hence, this study will serve as a baseline for future studies. The study was pragmatic, utilising glucometers for blood glucose measurements per MOH guidelines and standard MOH treatment registers that healthcare workers complete as our data source. We collected additional vital sociodemographic information that was lacking to improve our study. This approach enabled us to obtain a true reflection of services and patient outcomes that would have otherwise been lost in a controlled study. The first limitation is the missing data for follow-up blood glucose measurements. We provided health facilities with glucometers and glucose test strips to ensure completeness and consistency in measuring blood glucose. Despite this, some patients still missed blood glucose measurements during visits for different reasons, including changes in patient flow at health facilities, incomplete documentation, and limited orientation for new staff on patient follow-up procedures. This indicates that besides the availability of testing supplies, other health system factors can hinder patients from accessing a blood glucose test or further vital investigations. Secondly, one health facility did not respond to a request to participate in the study, which also impacted our final sample size. Thirdly, we could not fully assess patient conversions at 2 and 5 months due to the limited availability of sputum tests and the absence of culture during follow-up. Fourth, we had a few patients with our outcome of interest. Patient loss to follow-up could have been responsible for this, but those lost to follow-up were few. Finally, we used random blood glucose measurements per MOH guidelines. Noting that some patients do not receive the random blood glucose test to screen for elevated blood glucose as recommended by the MOH for different reasons, an HbA1c test at baseline and the end of treatment would provide more reliable estimates of blood glucose in the preceding three months. The fasting blood glucose test, an alternative, is similar to the random test but may provide similar results as most patients would have already had breakfast before getting to the clinic. Requesting patients to attend the clinic fasting during appointments would inconvenience the patients. It may negatively impact clinic visits since no meals are provided, and some patients walk to and fro the clinic.
RkJQdWJsaXNoZXIy MTk4NDMw