Cramm Jane M, Koolman Xander, Møller Valerie, Nieboer Anna P
Erasmus University Rotterdam, Institute of Health Policy & Management (iBMG), Rotterdam, The Netherlands.
Faculty of Technology, Policy and Management, Delft University of Technology, The Netherlands.
J Public Health Afr. 2011 Sep 5;2(2):e34. doi: 10.4081/jphia.2011.e34.
Few studies have investigated the interplay of multiple factors affecting the prevalence of tuberculosis in developing countries. The compositional and contextual factors that affect health and disease patterns must be fully understood to successfully control tuberculosis. Experience with tuberculosis in South Africa was examined at the household level (overcrowding, a leaky roof, social capital, unemployment, income) and at the neighbourhood level (Gini coefficient of inequality, unemployment rate, headcount poverty rate). A hierarchical random-effects model was used to assess household-level and neighbourhood-level effects on self-reported tuberculosis experience. Every tenth household in each of the 20 Rhini neighbourhoods was selected for inclusion in the sample. Eligible respondents were at least 18 years of age and had been residents of Rhini for at least six months of the previous year. A Kish grid was used to select one respondent from each targeted household, to ensure that all eligible persons in the household stood an equal chance of being included in the survey. We included 1,020 households within 20 neighbourhoods of Rhini, a suburb of Grahamstown in the Eastern Cape, South Africa. About one-third of respondents (n=329; 32%) reported that there had been a tuberculosis case within the household. Analyses revealed that overcrowding (P≤0.05) and roof leakage (P≤0.05) contributed significantly to the probability of a household tuberculosis experience experience, whereas higher social capital (P≤0.01) significantly reduced this probability. Overcrowding, roof leakage and the social environment affected tuberculosis prevalence in this economically disadvantaged community. Policy makers should consider the possible benefits of programs that deal with housing and social environments when addressing the spread of tuberculosis in economically poor districts.
很少有研究调查发展中国家影响结核病患病率的多种因素之间的相互作用。必须充分了解影响健康和疾病模式的构成因素和背景因素，才能成功控制结核病。研究在南非对家庭层面（过度拥挤、屋顶漏水、社会资本、失业、收入）和社区层面（不平等基尼系数、失业率、贫困人口比例）的结核病情况进行了考察。采用分层随机效应模型评估家庭层面和社区层面因素对自我报告的结核病经历的影响。在20个里尼社区中，每个社区每隔十户家庭被选入样本。符合条件的受访者年龄至少为18岁，且上一年在里尼居住至少六个月。使用基什方格从每个目标家庭中选择一名受访者，以确保家庭中所有符合条件的人都有平等机会被纳入调查。我们纳入了南非东开普省格雷厄姆斯敦郊区里尼20个社区内的1020户家庭。约三分之一的受访者（n = 329；32%）报告称家庭内曾有结核病病例。分析显示，过度拥挤（P≤0.05）和屋顶漏水（P≤0.05）显著增加了家庭出现结核病病例的可能性，而较高的社会资本（P≤0.01）则显著降低了这种可能性。在这个经济条件不利的社区，过度拥挤、屋顶漏水和社会环境影响了结核病患病率。政策制定者在应对经济贫困地区结核病传播问题时，应考虑处理住房和社会环境的项目可能带来的益处。
