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The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study
BACKGROUND: Although historically tuberculosis (TB) has been associated with poverty, few analytical studies from developing countries have tried to: 1. assess the relative impact of poverty on TB after the emergence of HIV; 2. explore the causal mechanism underlying this association; and 3. estimat...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117783/ https://www.ncbi.nlm.nih.gov/pubmed/21698146 http://dx.doi.org/10.1371/journal.pone.0020824 |
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author | Boccia, Delia Hargreaves, James De Stavola, Bianca Lucia Fielding, Katherine Schaap, Ab Godfrey-Faussett, Peter Ayles, Helen |
author_facet | Boccia, Delia Hargreaves, James De Stavola, Bianca Lucia Fielding, Katherine Schaap, Ab Godfrey-Faussett, Peter Ayles, Helen |
author_sort | Boccia, Delia |
collection | PubMed |
description | BACKGROUND: Although historically tuberculosis (TB) has been associated with poverty, few analytical studies from developing countries have tried to: 1. assess the relative impact of poverty on TB after the emergence of HIV; 2. explore the causal mechanism underlying this association; and 3. estimate how many cases of TB could be prevented by improving household socioeconomic position (SEP). METHODS AND FINDINGS: We undertook a case-control study nested within a population-based TB and HIV prevalence survey conducted in 2005–2006 in two Zambian communities. Cases were defined as persons (15+ years of age) culture positive for M. tuberculosis. Controls were randomly drawn from the TB-free participants enrolled in the prevalence survey. We developed a composite index of household SEP combining variables accounting for four different domains of household SEP. The analysis of the mediation pathway between household SEP and TB was driven by a pre-defined conceptual framework. Adjusted Population Attributable Fractions (aPAF) were estimated. Prevalent TB was significantly associated with lower household SEP [aOR = 6.2, 95%CI: 2.0–19.2 and aOR = 3.4, 95%CI: 1.8–7.6 respectively for low and medium household SEP compared to high]. Other risk factors for prevalent TB included having a diet poor in proteins [aOR = 3.1, 95%CI: 1.1–8.7], being HIV positive [aOR = 3.1, 95%CI: 1.7–5.8], not BCG vaccinated [aOR = 7.7, 95%CI: 2.8–20.8], and having a history of migration [aOR = 5.2, 95%CI: 2.7–10.2]. These associations were not confounded by household SEP. The association between household SEP and TB appeared to be mediated by inadequate consumption of protein food. Approximately the same proportion of cases could be attributed to this variable and HIV infection (aPAF = 42% and 36%, respectively). CONCLUSIONS: While the fight against HIV remains central for TB control, interventions addressing low household SEP and, especially food availability, may contribute to strengthen our control efforts. |
format | Online Article Text |
id | pubmed-3117783 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-31177832011-06-22 The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study Boccia, Delia Hargreaves, James De Stavola, Bianca Lucia Fielding, Katherine Schaap, Ab Godfrey-Faussett, Peter Ayles, Helen PLoS One Research Article BACKGROUND: Although historically tuberculosis (TB) has been associated with poverty, few analytical studies from developing countries have tried to: 1. assess the relative impact of poverty on TB after the emergence of HIV; 2. explore the causal mechanism underlying this association; and 3. estimate how many cases of TB could be prevented by improving household socioeconomic position (SEP). METHODS AND FINDINGS: We undertook a case-control study nested within a population-based TB and HIV prevalence survey conducted in 2005–2006 in two Zambian communities. Cases were defined as persons (15+ years of age) culture positive for M. tuberculosis. Controls were randomly drawn from the TB-free participants enrolled in the prevalence survey. We developed a composite index of household SEP combining variables accounting for four different domains of household SEP. The analysis of the mediation pathway between household SEP and TB was driven by a pre-defined conceptual framework. Adjusted Population Attributable Fractions (aPAF) were estimated. Prevalent TB was significantly associated with lower household SEP [aOR = 6.2, 95%CI: 2.0–19.2 and aOR = 3.4, 95%CI: 1.8–7.6 respectively for low and medium household SEP compared to high]. Other risk factors for prevalent TB included having a diet poor in proteins [aOR = 3.1, 95%CI: 1.1–8.7], being HIV positive [aOR = 3.1, 95%CI: 1.7–5.8], not BCG vaccinated [aOR = 7.7, 95%CI: 2.8–20.8], and having a history of migration [aOR = 5.2, 95%CI: 2.7–10.2]. These associations were not confounded by household SEP. The association between household SEP and TB appeared to be mediated by inadequate consumption of protein food. Approximately the same proportion of cases could be attributed to this variable and HIV infection (aPAF = 42% and 36%, respectively). CONCLUSIONS: While the fight against HIV remains central for TB control, interventions addressing low household SEP and, especially food availability, may contribute to strengthen our control efforts. Public Library of Science 2011-06-17 /pmc/articles/PMC3117783/ /pubmed/21698146 http://dx.doi.org/10.1371/journal.pone.0020824 Text en Boccia et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Boccia, Delia Hargreaves, James De Stavola, Bianca Lucia Fielding, Katherine Schaap, Ab Godfrey-Faussett, Peter Ayles, Helen The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study |
title | The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study |
title_full | The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study |
title_fullStr | The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study |
title_full_unstemmed | The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study |
title_short | The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study |
title_sort | association between household socioeconomic position and prevalent tuberculosis in zambia: a case-control study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117783/ https://www.ncbi.nlm.nih.gov/pubmed/21698146 http://dx.doi.org/10.1371/journal.pone.0020824 |
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