Abaynew Yeshewas, Ali Ahmed, Taye Girma
School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Sci Rep. 2025 May 7;15(1):15961. doi: 10.1038/s41598-025-01059-2.
Tuberculosis (TB) is a complex health problem that requires an integrated approach that considers economic, environmental, and social factors to reduce the global burden of TB. To develop a comprehensive strategy for TB eradication, addressing the social determinants of TB is crucial. This study aimed to explore the experiences of healthcare workers and patients regarding the social determinants of health in the context of TB in Addis Ababa, Ethiopia. Purposive sampling was employed to select 20 healthcare workers and 24 individuals with TB. Key informant interviews were conducted with healthcare workers managing TB patients and individuals with TB who presented at selected health centers. A semi-structured interview guide was used to collect the data. The guide included questions to capture participants' experiences of economic barriers, TB-related stigma, family and community support, food access, and housing conditions. Data were analyzed thematically and direct quotes were included. Forty-four participants were included, including 20 healthcare workers (16 men and four women) and twenty-four TB patients (nine men and 15 women). Key themes emerged, including economic barriers, with participants stating that financial constraints delayed TB care-seeking; stigma associated with TB, leading to fear of disclosure and social isolation; social support, with family and community networks playing a central role in facilitating care; food insecurity, with participants reporting the profound impact of food insecurity on TB vulnerability; exposure to smoke, with participants citing exposure to cigarette smoke as a potential risk factor for developing TB; and housing conditions, with participants stating that overcrowded living environments facilitate TB transmission. Economic barriers, TB-related stigma, a lack of social support, food insecurity, and exposure to cigarette smoke are key social determinants of TB. These findings underscore the need to address social determinants of TB through targeted interventions, such as stigma reduction campaigns, financial assistance, and community support programs, to reduce the TB burden in Addis Ababa.
结核病是一个复杂的健康问题，需要采取综合方法，考虑经济、环境和社会因素，以减轻全球结核病负担。要制定根除结核病的全面战略，解决结核病的社会决定因素至关重要。本研究旨在探讨埃塞俄比亚亚的斯亚贝巴结核病背景下医护人员和患者在健康社会决定因素方面的经历。采用目的抽样法选取了20名医护人员和24名结核病患者。对管理结核病患者的医护人员以及在选定健康中心就诊的结核病患者进行了关键 informant 访谈。使用半结构化访谈指南收集数据。该指南包括一些问题，以了解参与者在经济障碍、结核病相关耻辱感、家庭和社区支持、食物获取以及住房条件方面的经历。对数据进行了主题分析，并纳入了直接引语。共有44名参与者，包括20名医护人员（16名男性和4名女性）和24名结核病患者（9名男性和15名女性）。出现了一些关键主题，包括经济障碍，参与者表示经济限制导致寻求结核病治疗的延迟；与结核病相关的耻辱感，导致害怕披露病情和社会孤立；社会支持，家庭和社区网络在促进治疗方面发挥着核心作用；粮食不安全，参与者报告粮食不安全对结核病易感性有深远影响；接触烟雾，参与者指出接触香烟烟雾是患结核病的潜在风险因素；以及住房条件，参与者表示拥挤的生活环境有利于结核病传播。经济障碍、结核病相关耻辱感、缺乏社会支持、粮食不安全和接触香烟烟雾是结核病的关键社会决定因素。这些发现强调需要通过有针对性的干预措施，如减少耻辱感运动、财政援助和社区支持计划，来解决结核病的社会决定因素，以减轻亚的斯亚贝巴的结核病负担。
