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

Abstract

BackgroundMitigating the socioeconomic impact of tuberculosis (TB) is key to the WHO End TB Strategy. However, little known about socioeconomic well-being 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 to 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 (US$44.13 (IQR: US$0–US$106.15) vs US$72.20 (IQR: US$26.71–US$173.29), p<0.001), and more patients were living in poverty (earning <US$1.90/day: 57.7% (211/366) vs 41.6% (166/399), p<0.001) 1 year after TB-treatment completion compared with 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 ongoing 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.

Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae

“… 6 , 7 Individuals with chronic respiratory disease experience lower quality of life, 8 higher health-care use, 9 and reduced economic productivity compared with healthy individuals. 10 Individuals with chronic respiratory disease additionally face higher all-cause mortality, even with only mild lung impairment. 2 , 11 In addition to pulmonary damage, extrapulmonary tuberculosis disease and drug toxicity can cause permanent damage to other organ systems, as well as social and psychological sequelae.…”

Coverage and effectiveness of conditional cash transfer for people with drug resistant tuberculosis in Zimbabwe: a mixed methods study

“…Once a person is enrolled in DR-TB care and treatment duration is ascertained, the predictability and timeliness of CCT may be enhanced by ensuring that “disbursing CCT” becomes the default option. In light of a high prevalence of TB sequelae post DR-TB treatment and the associated income loss observed in this study and elsewhere, (40) extending CCT beyond treatment completion could be considered. Mitigation measures are needed to protect people and households against the socio-economic impacts of TB, including during periods of global shocks such as COVID-19.…”

“…(5,7) The pooled average of catastrophic costs, i.e. TB-related costs exceeding 20% of a household's annual income prior to TB was estimated globally at 43% (95% CI: [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] among TB affected households. (8) This is much higher than the End TB strategy milestone of zero catastrophic cost by 2020.…”

Willingness to seek medical care for tuberculosis and associated factors among the elderly population in Shenzhen: a cross-sectional study

“…29 This may explain the effects of economic situation on willingness to seek medical care for TB. Similarly, the economic burden has been found to be a key factor hindering health-seeking behaviours among TB patients, as well as a primary concern for TB control in India, 23 Indonesia, 30 Malawi, 31 the Middle East and North Africa. 32 To reduce the economic burden on TB patients, it is important for the government to expand health insurance coverage and lower the costs of TB treatment.…”