Abstract
Background: Drug-resistant Tuberculosis (DR-TB) is a disease affecting many South Africans. It is a public health threat and a growing burden on the South African healthcare budget. Poor socio-economic status (SES) and factors, such as job loss, overpopulation, poor hygiene, immunocompromising illnesses and malnourishment, have been identified as risk factors that influence this disease burden, hence it is commonly referred to as the disease of the poor. A better understanding of these factors will, indirectly improve TB treatment outcomes and ease the DR-TB burden in South Africa.
Aim and Objectives: The main aim of this research study was to identify socioeconomic factors that influence the risk of developing acquired DR-TB in patients who are retreated for TB in Tshwane, South Africa.
Methodology: This study used a quantitative, cross-sectional descriptive retrospective study design using secondary data. There were four healthcare facilities, which are decentralised sites for treating DR-TB, chosen in Tshwane Health District. The Electronic Drug-Resistant (EDRWeb) TB database of the Department of Health randomly selected TB patients from these facilities from the years 2018-2022, and only those who met the study’s inclusion criteria had their clinical folders retrieved for collection of secondary data using a data extraction tool.
Epidata v3.1 was used to enter data twice for verification, and the data was exported to STATA v15 for analysis after verification and coding. Descriptive analyses using percentages and counts for categorical variables and means, standard deviations and ranges for continuous variables were presented. Inferential analyses were conducted with a crude and adjusted logistic regression model with Odds Ratios. A stepwise approach was used to build the model and a p value of <0.05 was considered significant.
Results: A total of 128 patients records with drug-susceptible and drug-resistant TB from year 2018-2022 were retrieved from Tier.net and DR-TB electronic register EDRweb. The analysis revealed that out of the 128 retreated TB participants, 88 (68.8%) were DR-TB, black 67 (52.3%), males 58 (45.3%), not employed 56 (43.8%) between the ages of 26-35 years old 29 (22.7%), had no income 38 (29.7) and only had secondary education 52 (40.6%). The rest of the participants 40 (31.3%) were treated for DS-TB. Those completed TB treatment before were less likely (cOR;0.35; 95% Cl:0.15-0.74) to be retreated for DR-TB with statistical significance (p=0.007) compared to those who never completed TB treatment. Those who drank alcohol were more likely to be treated for DR-TB (cOR;1.62; 95% Cl:0.65-4.32).
Conclusion: The results in the inferential analyses did not show a significant association between MDR TB and socio-economic factors, however, the participants with MDR-TB did have a higher percentage of participants who were unemployed, did not have income, resided in a township with informal housing and living more than 5 km from the clinic.
Keywords: Tuberculosis, drug-resistant, socioeconomic factors , Tshwane health district, EDRweb