Abstract
Background: Tuberculosis (TB) remains a major public health concern in Mpumalanga, South Africa, disproportionately affecting disadvantaged communities. The province faces combined pressures of socio-economic deprivation, inadequate housing and sanitation, and environmental hazards linked to coal-based industries. These overlapping stressors contribute to poor respiratory health and sustain TB transmission. Understanding how sociodemographic and environmental factors interact is crucial for guiding targeted interventions in the province. Following the COVID-19 pandemic, TB cases increased due to reduced healthcare access and prolonged isolation. The study aims to identify social and environmental factors affecting TB prevalence among adults in Mpumalanga, South Africa, during 2021.
Study design and methods: A cross-sectional analytical study was conducted using secondary data from the 2021 General Household Survey (GHS). The analysis included adults aged 18 years and older. Self-reported TB status was used to determine TB outcomes. Sociodemographic variables include age, gender, education, employment status, household income, chronic disease, and marital status. Environmental variables included the main source of drinking water, sanitary facility and location, dwelling type, building material, number of rooms, household size, and access to electricity. Descriptive statistics summarized TB prevalence, and bivariate and multivariate logistic regression analyses were performed. Crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) were reported.
Results: Of the 2,019 participants, 155 (7.7%) reported TB. Bivariate and multivariate analysis revealed significant associations between TB and both sociodemographic and environmental factors. Older adults (55 years and older) had higher odds of TB (cOR 1.04; 95% CI 1.02–1.05). Household income was significant, with participants in higher-income categories (R1,500 and above) more likely to report TB (cOR 1.51), while those relying on remittances, pensions, or grants were less likely to have TB (cOR 0.96; 95% CI 0.95–0.97). Those who had completed matric were less likely to develop TB (cOR 0.96). Environmental factors showed strong effects. Living in flats or apartments increased TB odds (cOR 1.04; 95% CI 1.03–1.04), while residing in informal or backyard dwellings reduced risk (cOR 0.94; 95% CI 0.89–0.98). Larger dwellings with nine or more rooms (cOR 1.16; 95% CI 1.11–1.21) and bigger household sizes (cOR 1.07–1.14) were associated with higher TB prevalence. Access to groundwater (cOR 0.98) and communal water
v
supplies (cOR 0.97) were associated with a lower likelihood of TB infection compared to piped water. Similarly, having a flush toilet (cOR 0.98) or pit/bucket toilet (cOR 0.95) was protective compared to having no sanitary facilities.
Conclusion: Both sociodemographic and environmental conditions contribute to TB vulnerability in Mpumalanga. Interventions should prioritize reducing household overcrowding, improving access to safe water and sanitation, and addressing socio-economic inequalities. These findings can guide targeted provincial TB control strategies