Abstract
Background: Determinants of tuberculosis (TB) among the San community, which resides in settlement areas, contributes to the high tuberculosis disease burden in the marginalized community in Namibia. Research to identify these determinants can add to available limited Namibia San community national research literature; and based on scientific evidence, findings will establish the control and prevention measures to tuberculosis, particularly pulmonary tuberculosis (PTB). Objectives: The main objective was to evaluate the socio-demographic, lifestyle, occupational, environmental and health utilisation factors related to PTB in Ombili, Ondera, Farm Six and Tsumkwe; four San Settlement areas in Northern Namibia. Methods: This was a case-control study of the San, Tsumkwe constituency in among the region; and the neighbouring region, Oshikoto region in Tsumeb constituency in Namibia. The cases and controls were sampled from the study population seeking treatment at primary health facilities. Data were collected using a researcher-administered questionnaire. A total of 500 study participants were recruited, 250 pulmonary TB confirmed cases and 250 controls without TB. Logistic regression analysis was carried out using SPSS version 26, to evaluate the association between pulmonary TB and socio-demographic, lifestyle, occupational, health utilisation and environmental factors. Results and Discussion: The socio-demographic risk factors for developing pulmonary TB included low body weight participants; those in the weight range of 20 – 30 kg; 30.1 – 40 kg; 40.1 – 50 kg were more likely to develop pulmonary TB (AOR= 5.53; 95% CI:1.87 – 16.33); (AOR= 2.97 95% CI: 1.68 – 5.27); and (AOR= 2.59 95% CI:1.55 – 4.32) respectively. Overcrowding in households was a risk factor with households of 5 – 6 people (OR= 1.77;95% CI:1.05 – 3.00), households of 9 – 10 people (AOR= 2.74; CI:1.34 – 5.41), and households of > 10 (AOR= 2.61, 95% CI: 1.15 – 5.89). TB diagnosis was more likely in those previously diagnosed with TB (AOR= 18.73, 95% CI: 10.64 – 32.96). Those residing in Tsumkwe and non-listed Northern Namibian San Settlement residence (excluding Ombili, Farm Six and Ondera) compared to Tsintstabis were more likely to have pulmonary TB (AOR= 9.45, 95% CI: 3.91 – 22.84) respectively. Current smoking and previously having been a smoker were associated with pulmonary TB (AOR= 12.23, 95% CI:7.09 – 21.09) and (AOR= 9.94, 95% CI:3.43 – 20.84) respectively compared to never having smoked. Dwelling with a smoker in the household was found to have been associated with TB as with smokers (AOR= 6.06, 95% CI: 3.81 – 9.65), alcohol intake was more likely to have pulmonary TB (OR= 1.68, 95% CI: 1.16 – 2.44). On health utilisation, participants that hiked engine powered vehicles, as the mode of transport to travel to the clinic, compared to walking was associated with protective odds of pulmonary TB (OR= 0.58, 95% CI: 0.40 – 0.83)...
M.A. (Public Health)