南非耐多药肺结核（MDR-TB）患者的重度抑郁症和家庭食物不安全问题。
Major depression and household food insecurity among individuals with multidrug-resistant tuberculosis (MDR-TB) in South Africa.
机构信息
KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
出版信息
Soc Psychiatry Psychiatr Epidemiol. 2019 Mar;54(3):387-393. doi: 10.1007/s00127-019-01669-y. Epub 2019 Feb 13.
PURPOSE
Household food insecurity in South Africa is a pervasive public health challenge. Although its link to chronic health conditions is well established, its relationship to mental illness, particularly major depression, is not well-understood. Despite KwaZulu-Natal Province being the epicenter of the drug-resistant tuberculosis (MDR-TB) epidemic, and having the largest share of poverty in South Africa, this relationship remains unexamined. This study investigated the association between major depressive episode (MDE) and household food insecurity among individuals with MDR-TB.
METHODS
We enrolled and interviewed 141 newly admitted microbiologically confirmed MDR-TB inpatients at a specialized TB hospital in KwaZulu-Natal Province, South Africa. Logistic regression models were fitted to assess the relationship between MDE and household food insecurity, while accounting for socio-demographic status (e.g., age, gender, education, marital status, social grant status, income, and preference for living in one's community).
RESULTS
The prevalence of MDE and household food insecurity was 11.35% and 21.01%, respectively. MDE was significantly associated with household food insecurity (aOR 4.63, 95% CI 1.17-18.38). Individuals who are female (aOR 6.29, 95% CI 1.13-35.03), young (aOR 8.86, 95% CI 1.69-46.34), have low educational attainment (aOR 6.19, 95% CI 1.70-22.59) and receive social grants (aOR 7.60, 95% CI 2.36-24.48) were most at risk of household food insecurity.
CONCLUSIONS
MDE in individuals with MDR-TB was significantly associated with household food insecurity, independent of socio-economic status. Although MDR-TB is not exclusively a disease of the poor, individuals from socio-economically disadvantaged backgrounds (e.g., female, young adults, low education, and social grant recipients) were more likely to experience household food insecurity. Our study underscores the need to address the co-occurring cycles of food insecurity and untreated MDE in South Africa.
目的
南非的家庭粮食不安全是一个普遍存在的公共卫生挑战。尽管它与慢性健康状况的关系已得到充分证实，但它与精神疾病，特别是重度抑郁症的关系尚未得到很好的理解。尽管夸祖鲁-纳塔尔省是耐多药结核病（MDR-TB）疫情的中心，也是南非贫困人口最多的省份，但这一关系仍未得到研究。本研究调查了耐多药结核病患者中重度抑郁发作（MDE）与家庭粮食不安全之间的关系。
方法
我们在南非夸祖鲁-纳塔尔省的一家专门的结核病医院招募并采访了 141 名新入院的经微生物学确诊的耐多药结核病住院患者。我们使用逻辑回归模型评估了 MDE 与家庭粮食不安全之间的关系，同时考虑了社会人口统计学特征（例如年龄、性别、教育程度、婚姻状况、社会救助状况、收入和居住在自己社区的偏好）。
结果
MDE 和家庭粮食不安全的患病率分别为 11.35%和 21.01%。MDE 与家庭粮食不安全显著相关（调整后的优势比为 4.63，95%置信区间为 1.17-18.38）。女性（调整后的优势比为 6.29，95%置信区间为 1.13-35.03）、年轻（调整后的优势比为 8.86，95%置信区间为 1.69-46.34）、受教育程度低（调整后的优势比为 6.19，95%置信区间为 1.70-22.59）和领取社会救助金（调整后的优势比为 7.60，95%置信区间为 2.36-24.48）的个体最容易出现家庭粮食不安全。
结论
耐多药结核病患者的 MDE 与家庭粮食不安全显著相关，与社会经济地位无关。尽管耐多药结核病并不完全是穷人的疾病，但来自社会经济地位不利背景的个体（例如女性、年轻成年人、受教育程度低和领取社会救助金的人）更有可能经历家庭粮食不安全。我们的研究强调了在南非需要解决粮食不安全和未经治疗的 MDE 同时存在的问题。
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