Association of multidimensional poverty and tuberculosis in India

Abstract

Background Reduction of multidimensional poverty and tuberculosis are priority development agenda worldwide. The SDGs aims to eradicate poverty in all forms (SDG 1.2) and to end tuberculosis (SDG 3.3.2) by 2030. While poverty is increasingly being measured across multiple domains, reduction of tuberculosis has been an integral part of public health programmes. Though literature suggests a higher prevalence of tuberculosis among the economically poor, no attempt has been made to understand the association between multidimensional poverty and tuberculosis in India. The objective of this paper is to examine the association of multidimensional poverty and tuberculosis in India. Methods The unit data from the National Family Health Survey-4, conducted in 2015–16 covering 628,900 households and 2,869,043 individuals across 36 states and union territories of India was used in the analysis. The survey collected information on the self-reported tuberculosis infection of each member of a sample household at the time of the survey. Multidimensional poverty was measured in the domains of education, health, and standard of living, with a set of 10 indicators. The prevalence of tuberculosis was estimated among the multidimensional poor and non-poor populations across the states of India. A binary logistic regression model was used to understand the association of tuberculosis and multidimensional poverty. Results Results suggest that about 29.3% population of India was multidimensional poor and that the multidimensional poverty index was 0.128. The prevalence of tuberculosis among the multidimensional poor was 480 (95% CI: 464–496) per 100,000 population compared to 250 (95% CI: 238–262) among the multidimensional non-poor. The prevalence of tuberculosis among the multidimensional poor was the highest in the state of Kerala (1590) and the lowest in the state of Himachal Pradesh (220). Our findings suggest a significantly higher prevalence of tuberculosis among the multidimensional poor compared to the multidimensional non-poor in most of the states in India. The odds of having tuberculosis among the multidimensional poor were 1.82 times higher (95% CI, 1.73–1.90) compared to the non-poor. Age, sex, smoking, crowded living conditions, caste, religion, and place of residence are significant socio-demographic risk factors of tuberculosis. Conclusion The prevalence of tuberculosis is significantly higher among the multidimensional poor compared to the multidimensional non-poor in India.

Unique Reciprocal Association Seen Between Latent Tuberculosis Infection and Diabetes Is Due to Immunoendocrine Modulation (DM-LTB-1)

“…In contrast to diabetes and metabolic syndrome, isolated insulin resistance, under certain conditions, can confer some evolutionary advantage, at the organism level (Soeters and Soeters, 2012 ), and in this case anti-TB immunity. India has long been identified as an endemic zone for tuberculosis (Pathak et al, 2021 ) and is competing with China in becoming the diabetes capital of the world (Joshi and Parikh, 2007 ). The active implementation of the national end TB (NETB) program in India over the past several years might have reduced the LTBI burden (Dolla et al, 2019 ; Bhargava et al, 2021 ), which could have gradually contributed to the increase in diabetes, over the years (“metabolic hygiene hypothesis”) (Aravindhan and Anand, 2017 ).…”

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“… 17 Indian and WHO studies proved that Low body mass index, smoking, alcohol use disorders, indoor air pollution and widespread misuse of anti-tubercular drugs were major risk factors for tuberculosis. 22 , 23 The reduction of tuberculosis prevalence and mortality could be accompanied by growing incomes, improved housing and nutrition situations, and improved health literacy, 24 as proven in Western Europe, North America and some other parts of the world in the 1900s. 2 Moreover, the unfavourable trends in middle-aged (35–55 years) Indian adults indicated that malnutrition, poor hygienic practices and crowded environments resulting from poverty should be addressed as policy priorities.…”

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“…Desde una perspectiva social, probablemente no exista un mejor marcador del desarrollo humano de una sociedad (Estado-Nación) que su epidemiología de TBC. De esta forma, si se asocian variables como índice de desarrollo humano (IDH) e incidencia de esta enfermedad -inversamente proporcionales-se tiene una idea bastante real del grado de desarrollo de un país [6][7][8] (Figura 1).…”