The effect of household poverty on tuberculosis
OBJECTIVE To assess the relationship between household socio-economic level, both relative and absolute, and individual tuberculosis (TB) disease.
DESIGN: We analysed national TB prevalence surveys from eight countries individually and in pooled multicountry models. Socio-economic level (SEL) was measured in terms of both relative household position and absolute wealth. The outcome of interest was whether or not an individual had TB disease. Logistic regression models were used to control for putative risk factors for TB disease such as age, sex and previous treatment history.
RESULTS: Overall, a strong and consistent association between household SEL and individual TB disease was not found. Significant results were found in four individual country models, with the lowest socio-economic quintile being associated with higher TB risk in Mongolia, Myanmar, Tanzania and Viet Nam.
CONCLUSIONS: TB prevalence surveys are designed to assess prevalence of disease and, due to the small numbers of cases usually detected, may not be the most efficient means of investigating TB risk factors. Different designs are needed, including measuring the SEL of individuals in nested case-control studies within TB prevalence surveys or among TB patients seeking treatment in health care facilities.
Document Type: Research Article
Affiliations: 1: University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA; Global TB Programme, World Health Organization, Geneva, Switzerland 2: Global TB Programme, World Health Organization, Geneva, Switzerland 3: University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA 4: National TB Control Programme, Lilongwe, Malawi 5: Tropical Disease Foundation, Inc, Makati City, The Philippines 6: National Centre for Communicable Diseases, Ulaanbaatar, Mongolia 7: Directorate of Disease Surveillance and Research, Ministry of Health, Lusaka, Zambia 8: Tuberculosis and Other Respiratory Communicable Diseases Division, Rwanda Biomedical Centre, Rwanda Ministry of Health, Kigali, Rwanda 9: National TB Programme, Naypyidaw, Myanmar 10: Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
Publication date: December 1, 2016
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