Measuring socio-economic data in tuberculosis prevalence surveys

Leth, Frank van; Guilatco, Ruffy; Hossain, Md. Shabab; Hoog, Anja van’t; Hoa, Nguyen Binh; Werf, Marieke J. van der; Lönnroth, Knut

doi:10.5588/ijtld.10.0417

Cited by 17 publications

(18 citation statements)

References 6 publications

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“…The recent prevalence survey in Zambia observed prevalent TB was associated with lower SEP in urban areas but no association between prevalent TB and SEP in rural areas [8]. However, our results are consistent with large TB prevalence surveys from South India [1], the Philippines [5], Vietnam [5], Bangladesh [2,5,34], Shandong Province in China [7], Kenya [5] and Tanzania [9] which all found prevalent TB to be associated with lower SEP. They are also consistent with a prevalence survey in Zimbabwe which found a non-significant reduction in the odds of prevalent TB per asset owned in univariable analysis [4].…”

Section: Results In Contextsupporting

confidence: 86%

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Socio‐economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa

Yates

Ayles

Leacy

et al. 2018

Tropical Med Int Health

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ObjectiveTo describe the associations between socio‐economic position and prevalent tuberculosis in the 2010 ZAMSTAR Tuberculosis Prevalence Survey, one of the first large tuberculosis prevalence surveys in Southern Africa in the HIV era.MethodsThe main analyses used data on 34 446 individuals in Zambia and 30 017 individuals in South Africa with evaluable tuberculosis culture results. Logistic regression was used to estimate adjusted odds ratios for prevalent TB by two measures of socio‐economic position: household wealth, derived from data on assets using principal components analysis, and individual educational attainment. Mediation analysis was used to evaluate potential mechanisms for the observed social gradients.ResultsThe quartile with highest household wealth index in Zambia and South Africa had, respectively, 0.55 (95% CI 0.33–0.92) times and 0.70 (95% CI 0.54–0.93) times the adjusted odds of prevalent TB of the bottom quartile. College or university‐educated individuals in Zambia and South Africa had, respectively, 0.25 (95% CI 0.12–0.54) and 0.42 (95% CI 0.25–0.70) times the adjusted odds of prevalent TB of individuals who had received only primary education. We found little evidence that these associations were mediated via several key proximal risk factors for TB, including HIV status.ConclusionThese data suggest that social determinants of TB remain important even in the context of generalised HIV epidemics.

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Section: Results In Contextsupporting

confidence: 86%

“…Few prevalence surveys [1][2][3][4][5][6][7][8][9] have quantified the association between SEP and prevalent TB. Four [4,6,8,9] occurred in areas with generalised HIV epidemics.…”

Section: Introductionmentioning

confidence: 99%

Socio‐economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa

Yates

Ayles

Leacy

et al. 2018

Tropical Med Int Health

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“…The demographic data included age, sex, place of residence, levels of education and occupation. SEP was assessed by asset estimation 19. The symptom profile recorded the symptoms presented at first care seeking.…”

Section: Methodsmentioning

confidence: 99%

Care seeking in tuberculosis: results from a countrywide cluster randomised survey in Bangladesh

et al. 2014

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ObjectivesTo explore systematically the care seeking trajectories of tuberculosis (TB) cases up to four subsequent places of care and to assess the type of services provided at each place.MethodsTB cases detected actively during the 2007–2009 national TB prevalence survey and passively under the routine programme in the same period were interviewed by administering a standardised questionnaire. Care seeking and services provided up to four subsequent points were explored. Care seeking was further explored by categorising the providers into formal, informal and ‘self-care’ groups.ResultsA total of 273 TB cases were included in this study, of which 33 (12%) were detected during the survey and 240 (88%) from the TB registers. Out of the 118 passively detected cases who first sought care from an informal provider, 52 (44.1%) remained in the informal sector at the second point of care. Similarly, out of the 52, 17 (32.7%) and out of the 17, 5 (29.4%) remained in the informal sector at the third and fourth subsequent points of care, respectively. All the 33 actively detected cases had ‘self-care’ at the first point, and 27 (81.8%) remained with ’self-care’ up to the fourth point of care. Prescribing drugs (59–99%) was the major type of care provided by the formal and informal care providers at each point and was limited to the non-existent practice of investigation or referrals.ConclusionsFree TB services are still underutilised by TB cases and informal caregivers remained the major care providers for such cases in Bangladesh. In order to improve case detection, it is necessary that the National Tuberculosis Programme immediately takes effective initiatives to engage all types of care providers, particularly informal providers who are the first point of care for the majority of the TB suspects.

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“…30 Global programs for tuberculosis control rely heavily on metrics such as the case notification rate; the value of collecting and collating such programmatic data enables programs to assess progress in tuberculosis and to project need for further resource investment. However, a setting with significant wealth disparities in TB distribution may require more resources to achieve the same population-level impact on TB incidence than a setting with equivalent incidence but fewer disparities.…”

Section: Bringing Disparities Into Focus In Global Tuberculosis Controlmentioning

confidence: 99%

The epidemiological advantage of preferential targeting of tuberculosis control at the poor

Andrews

Basu

Dowdy

et al. 2015

int j tuberc lung dis

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Tuberculosis remains disproportionately concentrated among the poor, yet known determinants of tuberculosis reactivation may fail to explain observed disparities in disease rates according to wealth. Reviewing data on tuberculosis disparities in India and the wealth distribution of known tuberculosis risk factors, we describe how social mixing patterns could be contributing to tuberculosis disparities. Wealth-assortative mixing, wherein individuals are more likely to contact others from similar socioeconomic backgrounds, amplifies smaller differences in risk of tuberculosis, resulting in large population-level disparities. As disparities and assortativeness increase, tuberculosis becomes more difficult to control, an effect that is obscured by looking at population averages of epidemiological parameters, such as case detection rates. We illustrate how tuberculosis control efforts may benefit from preferential targeting toward the poor. In India, an equivalent-scale intervention could have a substantially greater impact if targeted to those living below the poverty line, compared with a population-wide strategy. In addition to potential efficiencies in targeting higher-risk populations, tuberculosis control efforts would reduce more secondary tuberculosis cases, per primary case diagnosed, if they were preferentially targeted to the poor. We highlight the need to collect programmatic data on tuberculosis disparities and explicitly incorporate equity considerations in tuberculosis control plans.

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Measuring socio-economic data in tuberculosis prevalence surveys

Cited by 17 publications

References 6 publications

Socio‐economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa

Socio‐economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa

Care seeking in tuberculosis: results from a countrywide cluster randomised survey in Bangladesh

The epidemiological advantage of preferential targeting of tuberculosis control at the poor

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