Timire Collins, Houben Rein M G J, Pedrazzoli Debora, Ferrand Rashida A, Calderwood Claire J, Bond Virginia, Mbiba Fredrick, Kranzer Katharina
Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
PLOS Glob Public Health. 2024 Jun 7;4(6):e0002745. doi: 10.1371/journal.pgph.0002745. eCollection 2024.
Tuberculosis (TB) disproportionally affects poor people, leading to income and non-income losses. Measures of socioeconomic impact of TB, e.g. impoverishment and patient costs are inadequate to capture non-income losses. We applied impoverishment and a multidimensional measure on TB and non-TB affected households in Zimbabwe. We conducted a cross-sectional study in 270 households: 90 non-TB; 90 drug-susceptible TB (DS-TB), 90 drug-resistant TB (DR-TB) during the COVID-19 pandemic (2020-2021). Household data included ownership of assets, number of household members, income and indicators on five capital assets: financial, human, social, natural and physical. Households with incomes per capita below US$1.90/day were considered impoverished. We used principal component analysis on five capital asset indicators to create a binary outcome variable indicating loss of livelihood. Log-binomial regression was used to determine associations between loss of livelihood and type of household. TB-affected households were more likely to report episodes of TB and household members requiring care than non-TB households. The proportions of impoverished households were 81% (non-TB), 88% (DS-TB) and 94% (DR-TB) by the time of interview. Overall, 56% (152/270) of households sold assets: 44% (40/90) non-TB, 58% (52/90) DS-TB and 67% (60/90) DR-TB. Children's education was affected in 33% (55/168) of TB-affected compared to 14% (12/88) non-TB households. Overall, 133 (50%) households experienced loss of livelihood, with TB-affected households almost twice as likely to experience loss of livelihood; adjusted prevalence ratio (aPR = 1.78 [95%CI:1.09-2.89]). The effect of TB on livelihood was most pronounced in poorest households (aPR = 2.61, [95%CI:1.47-4.61]). TB-affected households experienced greater socioeconomic losses compared to non-TB households. Multisectoral social protection is crucial to mitigate impacts of TB and other shocks, especially targeting poorest households.
结核病对贫困人口的影响尤为严重，会导致收入损失和非收入损失。衡量结核病社会经济影响的指标，如贫困程度和患者费用，不足以涵盖非收入损失。我们对津巴布韦受结核病影响和未受结核病影响的家庭应用了贫困程度和多维衡量方法。在2020 - 2021年新冠疫情期间，我们对270户家庭进行了横断面研究：90户未患结核病家庭；90户药物敏感型结核病（DS-TB）家庭，90户耐药型结核病（DR-TB）家庭。家庭数据包括资产所有权、家庭成员数量、收入以及关于五种资本资产的指标：金融资产、人力资产、社会资产、自然资产和物质资产。人均收入低于1.90美元/天的家庭被视为贫困家庭。我们对五种资本资产指标进行主成分分析，以创建一个表明生计丧失的二元结果变量。采用对数二项回归来确定生计丧失与家庭类型之间的关联。与未患结核病的家庭相比，受结核病影响的家庭更有可能报告结核病发作情况以及有家庭成员需要照料。到访谈时，贫困家庭的比例分别为：未患结核病家庭81%，药物敏感型结核病家庭88%，耐药型结核病家庭94%。总体而言，56%（152/270）的家庭出售了资产：未患结核病家庭44%（40/90），药物敏感型结核病家庭58%（52/90），耐药型结核病家庭67%（60/90）。受结核病影响家庭中有33%（55/168）的儿童教育受到影响，而未患结核病家庭这一比例为14%（12/88）。总体而言，133户（50%）家庭经历了生计丧失，受结核病影响的家庭经历生计丧失的可能性几乎是未患结核病家庭的两倍；调整患病率比（aPR = 1.78 [95%置信区间：1.09 - 2.89]）。结核病对生计的影响在最贫困家庭中最为明显（aPR = 2.61，[95%置信区间：1.47 - 4.61]）。与未患结核病的家庭相比，受结核病影响的家庭遭受了更大的社会经济损失。多部门社会保护对于减轻结核病及其他冲击的影响至关重要，尤其要针对最贫困家庭。
