Tuberculosis--A Complex Health Threat by Nieburg Phillip;Dubovi Talia;Angelo Sahil; & Talia Dubovi & Sahil Angelo

Author:Nieburg, Phillip;Dubovi, Talia;Angelo, Sahil; & Talia Dubovi & Sahil Angelo
Language: eng
Format: epub
ISBN: 9781442240957
Publisher: ROWMAN & LITTLEFIELD

Population-specific Complications of TB

Poverty

Tuberculosis is fundamentally a disease of poverty. It disproportionately affects the poor in part because of risk factors associated with poverty that increase susceptibility to TB: poor ventilation, overcrowded living and working conditions, and malnutrition.39 In addition, impoverished TB patients often lack access to health-care facilities that can provide treatment and prevention options and may also be malnourished or coinfected with another disease. These components of poverty can delay patient diagnosis and care, and consequently facilitate the spread of disease.

TB also perpetuates poverty. Specific costs to patients and families include the direct costs of transportation, health care visits, diagnostic tests, hospitalization, treatment drugs, and other household expenses, in addition to the indirect costs of lost income and time. A study reviewing TB program data from eight African countries found that the average pre-diagnosis costs alone (transport, lost wages, testing, and clinic costs) totaled catastrophic levels—defined as more than 20 percent of average family income.40 Another study of TB-related costs in Ghana, Vietnam, and the Dominican Republic found that the total direct and indirect costs were approximately equivalent to a year’s income and that inability to work and other indirect costs far exceeded the direct costs of treatment and care.41 The importance of these findings is that even if TB treatment costs were free (i.e., paid totally by the government), many families would still experience catastrophic costs.

Families of TB patients are often forced to take out loans or compel their children to support the family instead of attending school.42 In addition, the cost of care may push patients to delay seeking care or stop their treatment early, which causes TB to spread, and in the latter situation, to potentially become drug-resistant. In cases where patients have MDR-TB, the direct and indirect costs are even higher, but the treatment success rates are lower.43

In sum, TB and poverty are in a well-documented cycle where one drives the other, and many current policy documents acknowledge poverty as a core determinant of health. While explicit poverty reduction goals are beyond the scope of most health programs, TB interventions must be planned with a clear understanding of the role poverty plays in the prevention, transmission, and treatment of TB.

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