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The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting

Meghji, Jamilah ORCID:, Gregorius, Stefanie, Madan, Jason, Chitimbe, Fatima, Thomson, Rachael, Rylance, Jamie ORCID:, Banda, Ndaziona PK, Gordon, Stephen ORCID:, Corbett, Elizabeth, Mortimer, Kevin ORCID: and Squire, Bertie ORCID: (2021) 'The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting'. Thorax, Vol 76, Issue 4.

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Mitigating 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.

Adults ≥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.

405 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.

TB-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.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 300 Pulmonary tuberculosis
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Elly Wallis
Date Deposited: 07 Jan 2021 12:04
Last Modified: 25 Mar 2021 10:16


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