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American Journal of  Medical 
Science and Innovation (AJMSI) 

Prevalence, Patterns and Peculiarities of  Depression among Tuberculosis Patients
Attending Directly Observed Treatment Short-course (DOTS) Centers in

Lagos State Nigeria
Lilian Chinonso Okoro1, Oluwakemi Odukoya1, Aloysius Obinna Ikwuka2*, Francis Chigozie Udeh2

Volume 3 Issue 1, Year 2024
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v3i1.2653
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: March 21, 2024
Accepted: April 25, 2024
Published: April 29, 2024

Tuberculosis (TB) is an infectious disease that is life-threatening to vulnerable populations, 
and has been reported to be associated with depression. Nigeria is one of  the countries 
with a high TB burden, and with the current economic hardship in Nigeria, people are 
becoming poorer suggesting more TB patients are more likely to elapse into depression. The 
aim of  this research was to assess the prevalence, patterns and peculiarities of  depression 
among TB patients attending Directly Observed Treatment Short course (DOTS) centers 
in Lagos State, Nigeria. A descriptive, cross-sectional survey was conducted among 301 TB 
patients at 8 DOTS centers in Lagos State, Nigeria using a two-stage sampling method. 
Data was collected using interviewer-administered questionnaires to elicit responses from 
the TB patients. Patient Health Questionnaire-9 (PHQ-9) was used to determine and assess 
depression. Data was analyzed using SPSS version 23.0, with the Chi-square test being used to 
check for the association between socio-demographic characteristics and depression among 
the respondents. Mean age of  the respondents was 35.1±11.7 years. A majority (71.8%) of  
the respondents were males, 69.1% were Christians, Yorubas were most (52.2%), 88.4% 
earned ≤N150,000 monthly, and only 1 respondent had no formal education. The prevalence 
rate of  depression among the TB patients was 51.8%. Socio-demographic characteristics like 
gender (females were more affected), low financial status, and low educational level were 
associated with depression (p<0.05); unlike age, marital status, ethnicity, employment status, 
and family setting (p>0.05). Depression among TB patients is real as one in every two TB 
patients is depressed. Therefore, healthcare workers at DOTS centers should pay adequate 
attention to signs of  depression among their patients.

Keywords
Prevalence, Patterns, Peculiarities, 
Depression, Tuberculosis, DOTS 
Center, Nigeria

1 Department of  Community Health and Primary Care, University of  Lagos, Lagos State, Nigeria
2 College of  Medicine and Health Sciences, American International University West Africa, Banjul, The Gambia
* Corresponding author’s e-mail: aloysiussweet@yahoo.com

INTRODUCTION
Tuberculosis (TB) is a chronic granulomatous disease 
caused by Mycobacterium tuberculosis and commonly 
affects the lungs. Other affected organs in the body 
include the abdomen, spinal cord, etc. TB is characterized 
with monocytosis (Ikwuka, 2023e). TB is a chronic 
disease of  grave public health concern in Nigeria (World 
Health Organization (WHO), 2023a). In 2022, 7.5 million 
cases of  newly diagnosed TB infections were recorded 
with an estimated 1.3 million deaths caused by the 
infection (WHO, 2023a). World Health Organization 
further highlighted that Nigeria is among the thirty high 
TB burden countries that make up 87% of  world TB 
cases. In addition, Nigeria (4.5%) together with India, 
Indonesia, China, Philippines, Pakistan, Bangladesh, and 
the Democratic Republic (DR) of  the Congo, account for 
two-thirds of  the global TB cases (WHO, 2023a). 
In the previous year, 2021, Nigeria had the highest burden 
of  TB cases with a total of  467,000 cases (WHO, 2023b), 
and Lagos State accounted for 11% of  the total TB cases 
detected in Nigeria in the same year (Adebowale-Tambe, 
2022). The TB burden in Nigeria and other countries 
(China, DR Congo, India, Indonesia, Mozambique, 
Myanmar, Philippines, South Africa, and Zambia) is 
further compounded by the persistent HIV/AIDS 
epidemic and the emergence of  multi-drug resistant 

tuberculosis (MDR-TB) (WHO, 2023a). 
Closely mimicking TB is cystic fibrosis which is a genetic 
disease affecting mainly the lungs (Ikwuka, 2023a). Other 
affected organs include the pancreas, liver, kidneys, and 
intestine. Cystic fibrosis is caused by mutations in both 
copies of  the gene for cystic fibrosis transmembrane 
conductance regulator (CFTR) protein and has autosomal 
recessive mode of  inheritance (Ikwuka, 2023a). Clinical 
features of  cystic fibrosis include dyspnea, cough with 
sputum, sinusitis, poor growth, fatty stool, fingers and 
toes clubbing, etc (Ikwuka, 2023a).
Chronic metabolic disorders can worsen the clinical course 
and prognosis of  disease in patients with tuberculosis. 
Metabolic syndrome diseases, MSDs (Hypertension, 
Adiposity, Diabetes mellitus and Dyslipidemia) are 
interrelated diseases with very high morbidity and 
mortality rates (Ikwuka, 2015; Ikwuka, 2017a; Ikwuka, 
2017c; Ikwuka, 2023c; Ikwuka, 2023f; Virstyuk, 2016). 
Results from different studies have shown that high levels 
of  blood pressure, glucose and lipid metabolic disorders, 
asymptomatic hyperuricemia, activation of  systemic 
immune inflammation and fibrogenesis (also seen in 
chronic TB), contribute to kidney damage (Ikwuka, 
2017d; Ikwuka, 2017e; Ikwuka, 2018a; Ikwuka, 2018c; 
Ikwuka, 2018d; Ikwuka, 2019a; Ikwuka, 2019c; Ikwuka, 
2022; Ikwuka, 2023d; Virstyuk, 2017a; Virstyuk, 2018a; 



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Virstyuk, 2019; Virstyuk, 2021a; Virstyuk, 2021b). 
Chronic pulmonary TB is characterized with hemoptysis 
which can lead to anemia (Musa, 2023). Tuberculosis 
has also been linked with oxidative stress and different 
systemic immune inflammatory processes. In inducing 
oxidative stress, the major free radicals that are of  
physiological significance are superoxide anion, hydroxyl 
radical, and hydroperoxyl radical, while non-radical is 
hydrogen peroxide (Ikwuka, 2023b; Udeh, 2023a; Udeh, 
2023b). Rauwolfia vomitoria has a neuroprotective 
ability at it elevates antioxidants and suppresses lipid 
peroxidation (Ekechi, 2023a).
Depression is a commonly found mental disorder. 
Depression and anxiety are the leading causes of  mental 
disorders globally, with depression having a lifetime 
prevalence of  5 to 17%, with 12% being the average 
(Bains, 2023). The prevalence is almost twice as high 
in women than in men, simply because of  hormonal 
differences, childbirth effects, psychosocial stressors in 
men and women, and the behavioral model of  learned 
helplessness (Pederson, 2014). In 2019, 280 million 
people lived with depression (Institute of  Health Metrics 
and Evaluation (IHME), 2022); and in 2020, the number 
increased significantly by 28% due to the emergence of  
COVID-19 pandemic (WHO, 2022). Depression differs 
from usual mood fluctuations and short-lived emotional 
responses to challenges in everyday life. When long-
lasting with moderate or severe intensity, depression 
may become a serious health condition. It can cause the 
affected person to suffer greatly and poorly perform his 
or her duties. At its worst, depression can lead to suicide 
which results in an estimated 1 million deaths every year 
(WHO, 2022).
There are various barriers to effective care such as poorly 
trained healthcare providers, lack of  resources and social 
stigma associated with mental illnesses. The urgency of  the 
rate of  depression to public health is likely compounded 
by the recognition that, if  not effectively treated, it may 
elapse into a chronic disease. Just experiencing one 
episode of  depression places the individual at a 50% 
risk of  experiencing another, with subsequent episodes 
raising the likelihood of  experiencing more episodes in 
the future (National Institute of  Mental Health (NIMH), 
2021).
A study on depression among TB patients reported a 
prevalence of  45.5% especially in those with extensive TB 
pathology, older age, long illness duration, nuclear family 
and unmarried status (Ige, 2011). Recently, a systematic 
review and meta-analysis study conducted showed that 
depression is common among TB patients (Duko, 2020). 
A study on tuberculosis and comorbidities: treatment 
challenges in patients with comorbid diabetes mellitus and 
depression outlined that TB patients with depression or 
diabetes mellitus (TB-DM) both have an elevated risk of  
relapse, recurrence, and mortality. Relapse in TB treatment 
could also be caused by alcoholism and homelessness, 
as both coupled with depression could work in synergy 
to make the patient not to adhere to proper medication 

compliance (Cáceres, 2022). Compliance with treatment 
in chronic disorders has been established to be influenced 
by psychiatric disorders like depression (DeJean, 2013). 
Hence, it is safe to assume that prevention, prompt 
recognition and treatment of  depression in TB patients 
may help ensure treatment compliance which is crucial to 
the control of  TB.
In addition, Metabolic Syndrome Diseases (common 
comorbidities to TB) also require new and effective 
treatment regimens. Dapagliflozin which is a Sodium-
Glucose Linked Transporter 2 (SGLT-2) inhibitor and 
Liraglutide which is a Glucagon-like Peptide 1 Receptor 
Agonist (GLP-1 RA) have been found to increase the 
effectiveness of  treatment and improve the clinical course 
of  type 2 diabetes mellitus and hypertension in patients 
with such comorbidities (Ikwuka, 2017b; Ikwuka, 2018b; 
Ikwuka, 2019b; Ikwuka, 2021; Virstyuk, 2017b; Virstyuk, 
2018b; Virstyuk, 2018c). The hepatorenal protective 
functions of  coconut water in alloxan-induced type 1 
diabetes mellitus has also been documented (Ekechi, 
2023b).
Despite interventions and projects implemented globally 
and nationally to combat tuberculosis, the disease 
continues to pose a major public health threat. To achieve 
effective control, mechanisms may have to gear more 
towards patient-centeredness and exploring the human 
aspects of  control. There is insufficient information 
on the prevalence of  depression among TB patients in 
Nigeria, specifically in the Southwestern part of  Nigeria. 
Therefore, this study seeks to determine the prevalence 
of  depression among TB patients attending Directly 
Observed Treatment Short course (DOTS) centers in 
Lagos State, Nigeria.

MATERIALS AND METHODS
Study Setting
This descriptive, cross-sectional study was conducted 
in Lagos State which is the second most populous state 
in Nigeria. Due to heavy immigration from other states 
in Nigeria in search of  better economic prospects, the 
Lagos State population has become diverse with more 
than 250 ethnic groups as well as small minorities of  
American, British, Chinese, Greek, Syrian, etc. Lagos 
State is Nigeria’s largest urban area. However, 66% of  its 
population dwells in slums with no access to good roads, 
clean water, electricity, proper waste disposal, proper 
housing plans or good hygiene practices. Lagos State has 
a total of  78 DOTS centers and these centers are made 
up of  3 tertiary, 24 secondary, 31 primary, and 20 private 
centers.

Study Population and Sample Size Determination
The study population involves TB patients attending 
DOTS centers in Lagos State. With over 50,000 TB cases 
in Lagos State, Kish Leslie’s formula for cross-sectional 
studies to calculate the sample size was used (Okeke, 
2023a; Okeke, 2023b; Udeh, 2023c).
n=(Z2 PQ)/d2 



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Where,
n = minimum sample size required when the total 
population is greater than 10,000.
Z = standard normal deviate; set at 1.96 at 95% 
confidence level. 
P = incidence rate of  depression among TB patients from 
a previous study; (Baba, 2009) determined 27.7% (0.277).
Q = complementary proportion equivalent to 1-P, which 
is 0.723
d = degree of  accuracy desired (absolute precision), 
which is 5.0% (0.05).
Therefore: 
n = (1.962×0.277×0.723)/0.052 = 308
The minimum sample size for this study was 308. With 
the addition of  10% non-response rate, the sample size 
required for the study became 342.

Study Procedure
This study spanned a period of  4 months, from March 
2023 to June 2023. A list of  78 DOTS centers was 
obtained from the Lagos State Ministry of  Health. 
These comprise 3 tertiary centers, 24 secondary centers 
(made up of  1 Police, 2 Army, 2 Navy, 1 Air Force), 31 
primary centers (made up of  1 Police and 2 Prisons), and 
20 private centers (made up of  8 private not-for-profit 
(missionary) and 12 private for-profit health institutions). 
Eight DOTS centers were randomly selected using a table 
of  random numbers. They were: Nigerian Institute for 
Medical Research (61), Lagos State University Teaching 
Hospital (44), Mainland Hospital, Yaba (68), Lagos Island 
General Hospital (32), Randle General Hospital (39), Isolo 
General Hospital (20), Desile Primary Health Center (22), 
Ebute-Metta and Bariga LGA Primary Health Centers 
(15). The primary health centers were visited only once 
on their clinic days because the same patients would be 
seen while several visits were made to the other facilities 
to see different patients on different days.
TB patients in the outpatient departments of  the eight 
DOTS centers were selected. The patients were 18 years 
old or above, and voluntarily consented to participate in 
the study. TB patients below 18 years of  age, adult TB 

patients who did not consent, and in-patients were all 
excluded from this study. Data collection was done by 
the research team after being trained on the research 
procedure. Structured, pre-tested questionnaires with 
sections for the collection of  data on socio-demographic 
parameters, prevalence, patterns and peculiarities of  
depression among the respondents were used. Patient 
Health Questionnaire-9 (PHQ-9) to determine and assess 
depression was extracted from (Kroenke, 2002).

Data Analysis
Data was analyzed using descriptive statistics (frequencies, 
percentages, tables, graphs). Statistical Package for 
Social Sciences (SPSS) version 23.0 was used. Tests 
of  the association between depression and factors 
associated with it were done using the Chi-square test at 
a significance level (p-value) of  5%. The research team 
used PHQ-9 instrument scores (not at all “0”; few days 
“1”; more than half  the days “2”; nearly every day “3”). A 
total score below 4 indicates no depression, 5–9 indicates 
mild depression, 10–14 indicates moderate depression, 
15–19 indicates moderately severe depression, and 20–27 
indicates severe depression.

Ethical Considerations
Ethical consideration was sought from the Human 
Research and Ethics Committee of  the Lagos University 
Teaching Hospital (LUTH), Idi Araba, Surulere, Lagos 
State. Permission to conduct the study in DOTS centers 
was obtained from the Lagos State Primary Healthcare 
Board and the Lagos State Hospital Service Commission 
as well as voluntary consent obtained from participating 
TB patients after informed decision.

RESULTS
342 respondents were targeted for the study but only 301 
responded giving a response rate of  88%. The reason 
for this is that the DOT centers are very early morning 
clinics and some patients going to work or to their private 
businesses were impatient to wait to be interviewed. The 
results are expressed in tables and figures as follows:

Table 1: Socio-demographic characteristics of  respondents
Socio-demographics characteristics Frequency, n (%)
Age (in years) 
18-20 12 (4.0)
21-30 114 (37.9)
31-40 87 (28.9)
41-50 51 (16.9)
51-60 23 (7.6)
>60 14 (4.7)
Total 301 (100.0)
Mean age±standard deviation 35.2±11.75
Gender
Male 216 (71.8)



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Female 85 (28.2)
Total 301 (100.0)
Marital status
Single 153 (50.8)
Married 138 (45.8)
Divorced 6 (2.0)
Widowed 3 (1.0)
Separated 1 (0.3)
Total 301 (100.0)
Religion
Christianity 208 (69.1)
Islam 90 (29.9)
Traditional 3 (1.0)
Total 301 (100.0)
Ethnicity
Hausa 14 (4.7)
Ibo 81 (26.9)
Yoruba 157 (52.2)
Others 49 (16.3)
Total 301 (100.0)
Employed
Yes 152 (50.5)
No 149 (49.5)
Total 301 (100.0)
Estimated monthly income in Naira (N)
<30,000 (minimum wage in Nigeria) 72 (23.8)
30,000-100,000 154 (51.0)
100,001-150,000 41 (13.6)
>150,000 34 (11.6)
Total 301 (100.00)
Family setting
Nuclear 178 (59.1)
Extended 59 (19.6)
Polygamous 64 (21.3)
Total 301 (100.0)
Education
Primary 46 (15.3)
Secondary 135 (44.9)
Tertiary 119 (39.5)
No formal education 1 (0.3)
Total 301 (100.0)

The mean age was 35.2±11.75 years with the largest 
number of  respondents (37.9%) within the 21-30 years 
age group.  Males were 216 (71.8%) while females were 
85 (28.2%). 153 (50.8%) respondents were single, while a 
small percentage were either divorced (2.0%), widowed 
(1.0%), or separated (0.3%). Christian respondents 
were most (69.1%). 14 (4.7%) of  the respondents were 

Hausas, 26.9% were Ibos, and 52.2% were Yorubas. 
Employed (152) and unemployed (149) respondents were 
almost equal. Monthly income between N30,000 and 
N100,000 had the highest frequency (51.0%). Most of  
the respondents were from a nuclear home (59.1%), and 
just one TB patient had no formal education.



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Table 2 shows that 51 (16.9%) of  the TB patients had 
little interest or pleasure in doing things for more than 
half  the days while 36 (12.0%) had little interest nearly 
every day. 36 (12.0%) of  the respondents feel bad about 
themselves nearly every day while 15.9% had this feeling 
for a few days. 23 (7.6%) had trouble concentrating 

on things nearly every day, while 205 (68.1%) did not 
have any trouble concentrating on things. 19 (6.3%) 
harbor thoughts of  being better off  dead or of  hurting 
themselves in some way more than half  of  the day and 
nearly every day while 40 (13.3%) had this feeling for a 
few days.

Table 2: Prevalence of  depression among the respondents
Depression diagnostic criteria (n=301) Not at all 

n (%)
Few days 
n (%)

More than half  
the days, n (%)

Nearly every 
day, n (%)

Little interest or pleasure in doing things 142 (47.2) 72 (23.9) 51 (16.9) 36 (12.0)
Feeling down, depressed or hopeless 188 (62.5) 67 (22.3) 17 (5.6) 29 (9.6)
Trouble falling or staying asleep, or sleeping too much 161 (53.5) 68 (22.6) 43 (14.3) 29 (9.6)
Feeling tired or having little energy 142 (47.2) 85 (28.2) 43 (14.3) 31 (10.3)
Poor appetite or eating too much 180 (59.8) 50 (16.6) 22 (7.3) 49 (16.3)
Feeling bad about yourself- or that you are a failure or 
have let yourself  or your family down

203 (67.4) 48 (15.9) 14 (4.7) 36 (12.0)

Trouble concentrating on things, such as reading the 
newspaper or watching television

205 (68.1) 59 (19.6) 14 (4.7) 23 (7.6)

Moving or speaking so slowly so that other people could 
have noticed or the opposite - being so fidgety or restless 
that you have been moving around a lot more than usual

21 (70.8) 49 (16.3) 21 (7.0) 18 (6.0)

Thoughts that you would be better off  dead or of  
hurting yourself  in some way

223 (74.1) 40 (13.3) 19 (6.3) 19 (6.3)

PHQ-9 extracted from (Kroenke, 2001)

Table 3: Prevalence and severity of  depression among the respondents
Depression severity (n=301) Score Frequency, n (%)
Depression rate
Depressed 156 (51.8)
Not Depressed 145 (48.2)
Total 301 (100.0)
Severity of  depression (n=301)
None 0-4 145 (48.2)
Mild depression 5-9 64 (21.3)
Moderate depression 10-14 61 (20.3)
Moderately severe depression 15-19 22 (7.3)
Severe depression 20-27 9 (3.0)
Total 301 (100.0)

PHQ-9 score card extracted from (Kroenke, 2001)

Table 3 above shows that the prevalence of  depression 
among TB patients was 51.8%. The severity of  
depression among the respondents indicates that 48.2% 
of  the TB patients were not depressed, 21.3% had mild 
depression, 20.3% had moderate depression, 7.3% were 
had moderately severe depression, and 3% were severely 
depressed. 
Figure 1 shows that 61.1% of  the respondents found life 
as not difficult, 27.2% found life generally as somewhat 
difficult, 8.6% found life as very difficult, and 3.0% found 
life as extremely difficult.

Figure 1: Bar chart showing socio-occupational dysfunction 
among the respondents



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Table 4: Association between socio-demographic characteristics and depression status of  respondents
Prevalence

Depressed Not Depressed X2 Df p-value
Socio-demographic characteristics n (%) n (%)
Age (years)
18-20 4 (33.3) 8 (66.7) 10.550 5 0.059
21-30 60 (52.6) 54 (47.4) F-Exact
31-40 54 (62.1) 33 (37.9)
41-50 23 (45.1) 28 (54.9)
51-60 7 (30.4) 16 (69.6)
>60 8 (57.1) 6 (42.9)
Total 156 (51.8) 145 (48.2)
Gender
Male 104 (48.1) 112 (51.9) 4.147a 1 0.042
Female 52 (61.2) 33 (38.80)
Total 156 (51.8) 145 (48.2)
Marital status
Single 79 (51.6) 74 (48.4) 2.237 4 0.742
Married 73 (52.9) 65 (47.1) F-Exact
Divorced 2 (33.3) 4 (66.7)
Widowed 1 (33.3) 2 (66.7)
Separated 1 (100.0) 0 (0.0)
Total 156 (51.8) 145 (48.2)
Religion
Christianity 115 (55.3) 93 (44.7) 5.241 2 0.049
Islam 41 (45.6) 49 (54.4) F-Exact
Traditional 0 (0.0) 3 (100.0)
Total 156 (51.8) 145 (48.2)
Ethnicity
Igbo 42 (51.9) 39 (48.1) 3.953a 3 0.267
Yoruba 88 (56.1) 69 (43.9)
Hausa 6 (42.9) 8 (57.1)
Others 20 (40.8) 29 (59.2)
Total 156 (51.8) 145 (48.2)
Employed
Yes 73 (48.0) 79 (52.0) 1.777a 1 0.183
No 83 (55.7) 66 (44.3)
Total 156 (51.8) 145 (48.2)
Estimated monthly income in Naira (N)
<30,000 25 (71.4) 10 (28.6) 11.596a 3 0.009
30,000-100,000 34 (45.3) 41 (54.7)
100,001-150,000 6 (30.0) 14 (70.0)
>150,000 6 (35.3) 11 (64.7)
Total 71 (48.3) 76 (51.7)
Family setting
Nuclear 97 (54.5) 81 (45.5) 1.618a 2 0.445
Extended 30 (50.8) 29 (49.2)
Polygamous 29 (45.3) 35 (54.7)



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Total 156 (51.8) 145 (48.2)
Education level
Primary 16 (34.8) 30 (65.2) 8.119 3 0.027
Secondary 78 (57.8) 57 (42.2) F-Exact
Tertiary 61 (51.3) 58 (48.7)
No formal education 1 (100.0) 0 (0.0)
Total 156 (51.8) 145 (48.2)

Table 4 shows that the age group 21-30 years were the 
most depressed with 60 respondents out of  the 156 
depressed respondents. On gender, 48.1% males were 
depressed. The depressed/not depressed ratio among 
the single respondents was 51.6:48.4. More of  the 
depressed TB patients were unemployed (55.7%). 71.4% 
of  the respondents earning less than the minimum 
wage (N30,000) were depressed, while 35.3% of  the 
respondents earning above N150,000 monthly were 
depressed. 57.8% of  the respondents who were secondary 
school leavers were depressed.
 
DISCUSSION
Tuberculosis (TB) is an infectious disease that requires 
proper treatment and management to prevent its spread 
and fatality in infected individuals. TB has been reported 
to be associated with mental illnesses such as depression 
(Duko, 2020; WHO, 2023a). Thus, it is crucial to analyze 
the population index of  the disease and understand how 
TB patients are coping with depression.  
The mean age of  TB patients in this study was 35.2±11.75 
years, slightly above the 30-year mean age in the study 
of  (Salodia, 2019). Patients between ages 21 and 50 years 
accounted for 83.7% of  the sample size, this gives a 
clue that TB infection is common among the workforce 
population and less common among the people below 
21 and above 50 years of  age, who are being catered for. 
Males are more infected than females as males accounted 
for 71.8% of  the respondents, just as was found in the 
studies of  (Dahiya, 2017) and (Salodia, 2019). This could 
also be related to the fact that men actively interact with 
people more than women daily. Single or unmarried 
patients accounted for half  (50.8%) of  the respondents, 
suggesting a wide spectrum of  interaction for the 
unmarried compared to married, divorced, widowed, or 
separated individuals. This supports (Dahiya, 2017) study.
Most of  the respondents were Christians and over half  
(52.2%) were Yorubas. This indicates that Lagos State is 
dominated by adherents of  the Christian religion and that 
the Yorubas in the state are the people mostly infected 
with tuberculosis. Almost half  (49.5%) of  the respondents 
were unemployed, indicating the need for the Lagos State 
government to improve on employment of  the masses. 
However, TB infection is equally distributed among the 
unemployed and employed. TB is more prevalent among 
people earning a low monthly income of  N100,000 or 
less as compared to people earning a higher income 
(>N100,000), as illustrated by findings in this study and 

in the study of  (Dahiya, 2017). This study also proves that 
tuberculosis is distributed across every level of  education.
A high (51.8%) prevalence of  depression among the 
participants was recorded in this study. This prevalence 
rate was higher than the 23.6% found in New Delhi 
(Salodia, 2019), 30% in Lesotho (Larson, 2017), 31.1% in 
Ethiopia (Molla, 2019), and 45.5% in Oyo State, Nigeria 
(Ige, 2011). The value in this present study is almost the 
same as the 51.9% in Eastern Ethiopia reported by (Dasa, 
2019), 69.55% in Pakistan (Javaid, 2017), and 80% in 
Pakistan (Anwar, 2010). 
The variation in the prevalence of  depression could be 
attributed to various factors such as socio-occupational 
dysfunction, presentation of  TB symptoms, prolonged 
drug therapy duration, HIV status, other comorbidities 
e.g. MSDs, stigma from family and friends, denial of  
communal privileges, family support, period of  diagnosis 
of  TB, stage of  treatment, the distance to a treatment 
center, and the attitude of  treatment center staff. 
Analyzing the socio-occupational dysfunction of  the 
respondents, 61.1% of  them found life as not difficult, 
27.2% found life as somewhat difficult, 8.6% found life as 
very difficult, and 3.0% found life as extremely difficult.
The prevalence of  depression among the 301 respondents 
can be summarized as 48.2% (no depression), 21.3% 
(mild depression), 20.3% (moderate depression), 7.3% 
(moderately severe depression), and 3.0% (severe 
depression). This means that 89.7% of  the respondents 
are most likely to comply to proper medication because 
they are either not depressed or have mild or moderate 
depression, yielding a better treatment outcome for the 
tuberculosis infection. Additionally, from this study, it 
can be stated that out of  20 depressed TB patients: 16 
will be mildly and moderately depressed (evenly shared); 
3 moderately severely depressed; and 1 will be severely 
depressed.
The association between socio-demographic 
characteristics and depression status of  the participants 
shows that age, marital status, ethnicity, employment 
status, and family setting were not associated with 
depression. The relationship between marital status and 
depression in this present study aligns with the study of  
(Salodia, 2019). 
Apart from these socio-demographic parameters, gender 
shows a significant association with depression, opposing 
the result of  (Salodia, 2019).  The ratio of  depressed 
female participants was significantly higher (p=0.042) 
than the ratio of  depressed male participants. Women 



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are the caregivers in the home, and being unable to 
render this care due to morbidity of  TB and the fear 
of  communicating the disease to their family members 
might contribute to their vulnerability to depression. 
Religion was found to be slightly associated with 
depression (p=0.049). With more Christian and less 
Muslim participants being depressed, the reason for this 
disparity could be slated for further studies. 
Financial status was significantly associated with 
depression (p=0.009) as a high percentage of  participants 
earning N100,000 or less were depressed and only a 
low percentage of  those earning over N100,000 were 
depressed. This is consistent with the study of  (Aniebue, 
2007). Financial stability is essential to maintain a good 
health. Patients under treatment are always advised to eat 
a balanced diet adequately and maintain healthy lifestyles. 
With financial hardship being experienced, patients may 
be unable to afford adequate balanced meals or lifestyles. 
The combination of  poverty and a debilitating illness like 
tuberculosis could be responsible for depression among 
low-income earners.
Depression was also found to be associated with 
educational level (p=0.027). This study shows that more 
educated participants were more depressed. This is 
because a less educated person will not be exposed to 
more information about TB which can boost his morale 
and alter negative mindsets that may make him/her elapse 
into depression.
The strength of  this study lies in the fact that a standard 
PHQ-9 was used to extract information to determine and 
assess depression among the participants. The researchers 
were adequately trained before the study to collect 
accurate data during interviews with the participants, and 
the sincerity of  the participants was commendable. This 
study is limited in the aspect of  identifying the occupation 
of  the respondents and determining the association 
between occupation, TB infection  and depression. It was 
challenging to persuade respondents to wait because they 
were always in a rush to leave the center and go to work 
since the DOTS centers only schedule early morning 
clinics for TB patients on weekdays. Prospect for further 
study is to determine knowledge, attitude and factors 
associated with depression in TB patients.

CONCLUSION
Tuberculosis is a chronic, debilitating disease with high 
morbidity and mortality, thus making coping with general 
life activities difficult. A TB patient’s inability to cope 
with the disease may influence his or her vulnerability to 
depression.

Acknowledgment 
Special thanks to all the respondents who voluntarily 
participated in this study after making an informed 
decision.

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