Patterns of alcohol use among female tuberculosis (TB) patients in hard-to-reach, pastoralist populations in northern Kenya

Previous studies have found an association between heavy alcohol use and TB. In many societies, alcohol consumption is a gendered behavior, with men drinking more alcohol than women. Yet, the influence of alcohol on TB among women should not be dismissed. Using in-depth interviews, focus groups and a case-control study, this research explored the role of alcohol among adult female TB patients (> 15 years) in two district hospitals in hard-to-reach areas in northern Kenya. In the case-control study, 26% of 117 TB patients were current drinkers compared with 18% of 234 outpatient controls. TB patients were more likely to be heavy, chronic drinkers (OR 2.9; 95%CI 1.23-6.99) compared with outpatients. Among drinkers, TB patients were more likely to primarily consume home brewed alcohols (OR 3.1; 95%CI 1.6-5.9), spend an average of an hour per day in bars or beer huts (OR 3.9; 95%CI 2.1-7.6), and brew and sell illicit alcohol (OR 6.3; 95%CI 2.9-13.6). Qualitative research showed that illegal and potent home brewed alcohols (e.g. changaa) were cheaper and more accessible than commercial alcohols. Brewing and selling alcohol often took place in small, closed and crowded spaces, which may increase risk of exposure to TB infection and indoor smoke inhalation, and thus risk of TB disease. Recommendations include screening for heavy alcohol use among women in TB wards for referral to counseling or treatment, targeting brewers in an education campaign linking TB and alcohol and encouraging health care workers to discuss healthy alcohol use among women during routine care.