TY - JOUR
T1 - The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting
AU - Meghji, Jamilah
AU - Gregorius, Stefanie
AU - Madan, Jason
AU - Chitimbe, Fatima
AU - Thomson, Rachael
AU - Rylance, Jamie
AU - Banda, Ndaziona P.K.
AU - Gordon, Stephen
AU - Corbett, Elizabeth L.
AU - Mortimer, Kevin
AU - Squire, Bertie
PY - 2021/3/15
Y1 - 2021/3/15
N2 - BackgroundMitigating the socioeconomic impact of tuberculosis is key to the WHO End TB Strategy. However, ittle known about socioeconomic wellbeing beyond TB-treatment completion. In this mixed-methods study we describe socioeconomic outcomes after TB-disease in urban Blantyre, Malawi, and explore pathways and barriers to financial recovery. MethodsAdults ≥15 years successfully completing treatment for a first episode of pulmonary TB under the National TB Control Programme were prospectively followed-up for 12-months. Socioeconomic, income, occupation, health-seeking and cost data were collected. Determinants and impacts of ongoing financial hardship were explored through illness narrative interviews with purposively selected participants. Results405 participants were recruited from February 2016 - April 2017. Median age was 35-years (IQR: 28- 41), 67.9% (275/405) were male, and 60.6% (244/405) were HIV-positive. Employment and incomes were lowest at TB-treatment completion, with limited recovery in the following year: fewer people were in paid work (63.0% [232/368] vs. 72.4% [293/405], p=0.006), median incomes were lower ($44.13 [IQR: $0-106.15] vs. $72.20 [IQR: $26.71-173.29], p<0.001), and more patients were living in poverty (earning <$1.90/day: 57.7% [211/366] vs. 41.6% [166/399], p<0.001) 1-year after TB- treatment completion compared to before TB-disease onset. Half of the participants (50.5%, 184/368) reported ongoing dissaving (use of savings, selling assets, borrowing money) and 9.5% (35/368) reported school interruptions in the year after TB-treatment completion. Twenty-one participants completed in-depth interviews. Reported barriers to economic recovery included financial insecurity, challenges rebuilding business relationships, residual physical morbidity, and stigma.ConclusionsTB-affected households remain economically vulnerable even after TB-treatment completion, with limited recovery in income and employment , persistent financial strain requiring dissaving, and school interruptions. Measures of the economic impact of TB-disease should include the post-TB period. Interventions to protect the long-term health and livelihoods of TB survivors must be explored.
AB - BackgroundMitigating the socioeconomic impact of tuberculosis is key to the WHO End TB Strategy. However, ittle known about socioeconomic wellbeing beyond TB-treatment completion. In this mixed-methods study we describe socioeconomic outcomes after TB-disease in urban Blantyre, Malawi, and explore pathways and barriers to financial recovery. MethodsAdults ≥15 years successfully completing treatment for a first episode of pulmonary TB under the National TB Control Programme were prospectively followed-up for 12-months. Socioeconomic, income, occupation, health-seeking and cost data were collected. Determinants and impacts of ongoing financial hardship were explored through illness narrative interviews with purposively selected participants. Results405 participants were recruited from February 2016 - April 2017. Median age was 35-years (IQR: 28- 41), 67.9% (275/405) were male, and 60.6% (244/405) were HIV-positive. Employment and incomes were lowest at TB-treatment completion, with limited recovery in the following year: fewer people were in paid work (63.0% [232/368] vs. 72.4% [293/405], p=0.006), median incomes were lower ($44.13 [IQR: $0-106.15] vs. $72.20 [IQR: $26.71-173.29], p<0.001), and more patients were living in poverty (earning <$1.90/day: 57.7% [211/366] vs. 41.6% [166/399], p<0.001) 1-year after TB- treatment completion compared to before TB-disease onset. Half of the participants (50.5%, 184/368) reported ongoing dissaving (use of savings, selling assets, borrowing money) and 9.5% (35/368) reported school interruptions in the year after TB-treatment completion. Twenty-one participants completed in-depth interviews. Reported barriers to economic recovery included financial insecurity, challenges rebuilding business relationships, residual physical morbidity, and stigma.ConclusionsTB-affected households remain economically vulnerable even after TB-treatment completion, with limited recovery in income and employment , persistent financial strain requiring dissaving, and school interruptions. Measures of the economic impact of TB-disease should include the post-TB period. Interventions to protect the long-term health and livelihoods of TB survivors must be explored.
KW - health economics
KW - post-TB lung disease
KW - Pulmonary tuberculosis
KW - social determinants
KW - TB sequelae
U2 - 10.1136/thoraxjnl-2020-215338
DO - 10.1136/thoraxjnl-2020-215338
M3 - Article
SN - 0040-6376
VL - 76
SP - 387
EP - 395
JO - Thorax
JF - Thorax
IS - 4
ER -
