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Potential effect of household environment on prevalence of tuberculosis in India: evidence from the recent round of a cross-sectional survey.

ABSTRACT: BACKGROUND:Tuberculosis (TB) has been a major health problem globally since ages, and even today, it is a major cause of morbidity in millions of people each year. In 2015 alone, TB accounted for about 1.4 million deaths globally, with India carrying the biggest burden of the disease. The physical environment of the household, an individual living in, has a significant influence on the incidence of TB. Thus, an understanding of the socio-economic, demographic and environmental factors that individuals are exposed to is of importance. The objective of present study is to examine the association of household environment with the prevalence of Tuberculosis in India. METHODS:The study utilizes data from the fourth round of National Family Health Survey (NFHS-4), 2015-16, which was collected from self-reported information pertaining to Tuberculosis in the household questionnaire. The specific question was, "Does any usual resident of your household suffer from tuberculosis?" the response to which helped in the detection of Tuberculosis. Binary Logistic regression was performed from which appropriate inferences are drawn on the association of household environment with Tuberculosis. RESULTS:Prevalence of TB was found to be the highest among elderly people (0.9%), no education (0.4%) and people belonging to the poorest wealth quintile (0.53%). Family members who were regularly (daily) exposed to smoke (second-hand smoke) inside the house were more prone to getting tuberculosis (OR?=?1.49; CI?=?1.39-1.61) as compared with households where people do not smoke inside the house. Further, households having a finished wall (OR?=?0.7; CI?=?0.6-0.8) are less likely to get TB than the households with mud walls. Households that shared their toilets with other households are more likely to get hold of Tuberculosis (OR?=?1.2; CI?=?1.1-1.4). CONCLUSIONS:Results strongly suggest that a contaminated household environment increases the risk of tuberculosis in India. There are multiple risk factors that are strongly associated with Tuberculosis: smoke inside house, type of cooking fuel, separate kitchen, floor, roofing and wall material, number of persons sleeping in a room, sharing toilet and potable water with other households; and individual characteristics such as age, sex, educational attainment, marital status, place of residence and wealth index.

SUBMITTER: Singh SK

PROVIDER: S-EPMC5934826 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Potential effect of household environment on prevalence of tuberculosis in India: evidence from the recent round of a cross-sectional survey.

Singh S K SK Kashyap Gyan Chandra GC Puri Parul P

BMC pulmonary medicine 20180503 1

<h4>Background</h4>Tuberculosis (TB) has been a major health problem globally since ages, and even today, it is a major cause of morbidity in millions of people each year. In 2015 alone, TB accounted for about 1.4 million deaths globally, with India carrying the biggest burden of the disease. The physical environment of the household, an individual living in, has a significant influence on the incidence of TB. Thus, an understanding of the socio-economic, demographic and environmental factors th ...[more]

PMID: 29724218

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Project description:BackgroundHousehold environment condition is an important predictor of morbidity of the household members. Without forming a healthy household environment, creating a healthy population is not possible. In this background, this study assesses the impact of change in household environment conditions on morbidity.MethodsFor the empirical analysis purpose of this study, we used two waves of longitudinal data from India Human Development Survey (2004-05, 2011-12). This study is based on 34131 re-contacted households in 2011-12 from the base year 2005. The bivariate and ANOVA tests were performed to assess any short-term morbidity (diarrhoea, fever and cough) with respect to change in household environment condition from 2005 to 2011. The multivariate linear regression was performed to assess the impact of change in household environment conditions on morbidity. The multinomial logistic regression was used to assess the impact of change in household environment condition on change in morbidity.ResultsThe results from multivariate linear regression have shown that the share of household members fell sick due to any short-term morbidity (ASM) was significantly lower (? = -0.060, P<0.001) among the households who lived in clean environment condition in both the periods, 2004-05 and in 2011-12 as compared to those who were living in poor environment condition in both periods net of other socio-economic characteristics of the households. The share of household members fell sick due to any short-term morbidity has significantly declined (? = -0.051, P<0.001) among the household whose household environment condition has changed from poor in 2004-05 to clean environment in 2011-12 as compared to the households who have lived in poor environment condition in both periods in 2004-05 and 2011-12. The results of adjusted percentage from multinomial logistic regression have shown that the household members who fell sick with ASM was remained higher (4.9%; P<0.05) among the households whose environment condition was remained poor in both years in 2005 and 2011 as compared to the other households (2.7%) who remained in the better-off condition in both years in 2005 and 2011.ConclusionConsidering the findings of the study, we suggest that ongoing government flagships programmes such as Swacch Bharat Mission (Clean India Mission), Pradhan Mantri Ujjwala Yojana (Prime Minister Clean Energy Scheme) and Pradhan Mantri Awas Yojana (Prime Minister Housing Scheme), and Jal Jeevan Mission (Improved Source of Drinking Water Scheme) should work in tandem to improve household environment conditions.

Project description:BackgroundThe comorbid presence of tuberculosis and diabetes mellitus has become an increasingly important public health threat to the prevention and control of both diseases. Thus, household contact investigation may serve a dual purpose of screening for both tuberculosis and diabetes mellitus among household contacts. We therefore aimed to evaluate the coverage of screening for tuberculosis and diabetes mellitus among household contacts of tuberculosis index cases and to determine predictors of tuberculosis screening.MethodsA household-based survey was conducted in February 2019 in Muang district of Phatthalung Province, Thailand where 95 index tuberculosis patients were newly diagnosed with pulmonary or pleural tuberculosis between October 2017 and September 2018. Household contacts of the index patients were interviewed using a structured questionnaire to ascertain their past-year history of tuberculosis screening and, if appropriate, diabetes mellitus screening. For children, the household head or an adult household member was interviewed as a proxy. Coverage of tuberculosis screening at the household level was regarded as households having all contacts screened for tuberculosis. Logistic regression and mixed-effects logistic regression models were used to determine predictors of tuberculosis screening at the household and individual levels, respectively, with the strengths of association presented as adjusted odds ratios (AOR) and 95% confidence intervals (CI).ResultsOf 61 responding households (64%), complete coverage of tuberculosis screening at the household level was 34.4% and among the 174 household contacts was 46.6%. About 20% of contacts did not receive any recommendation for tuberculosis screening. Households were more likely to have all members screened for tuberculosis if they were advised to be screened by a healthcare professional rather than someone else. At the individual level, contacts aged ?35?years (AOR: 30.6, 95% CI: 2.0-466.0), being an employee (AOR: 0.1, 95% CI: 0.0-0.8) and those who had lived more than 5?years in the same household (AOR: 0.1, 95% CI: 0.0-0.8) were independent predictors for tuberculosis screening. Coverage of diabetes mellitus screening was 80.6% with lack of awareness being the main reason for not being screened.ConclusionsCompared to diabetes screening, the coverage of tuberculosis screening was low. A better strategy to improve coverage of tuberculosis contact screening is needed.

Project description:BackgroundIn high HIV burden settings, maximising the coverage of prevention strategies is crucial to achieving epidemic control. However, little is known about the reach and effect of these strategies in some communities.MethodsWe did a cross-sectional community survey in the adjacent Greater Edendale and Vulindlela areas in the uMgungundlovu district, KwaZulu-Natal, South Africa. Using a multistage cluster sampling method, we randomly selected enumeration areas, households, and individuals. One household member (aged 15-49 years) selected at random was invited for survey participation. After obtaining consent, questionnaires were administered to obtain sociodemographic, psychosocial, and behavioural information, and exposure to HIV prevention and treatment programmes. Clinical samples were collected for laboratory measurements. Statistical analyses were done accounting for multilevel sampling and weighted to represent the population. A multivariable logistic regression model assessed factors associated with HIV infection.FindingsBetween June 11, 2014, and June 22, 2015, we enrolled 9812 individuals. The population-weighted HIV prevalence was 36·3% (95% CI 34·8-37·8, 3969 of 9812); 44·1% (42·3-45·9, 2955 of 6265) in women and 28·0% (25·9-30·1, 1014 of 3547) in men (p<0·0001). HIV prevalence in women aged 15-24 years was 22·3% (20·2-24·4, 567 of 2224) compared with 7·6% (6·0-9·3, 124 of 1472; p<0·0001) in men of the same age. Prevalence peaked at 66·4% (61·7-71·2, 517 of 760) in women aged 35-39 years and 59·6% (53·0-66·3, 183 of 320) in men aged 40-44 years. Consistent condom use in the last 12 months was 26·5% (24·1-28·8, 593 of 2356) in men and 22·7% (20·9-24·4, 994 of 4350) in women (p=0·0033); 35·7% (33·4-37·9, 1695 of 5447) of women's male partners and 31·9% (29·5-34·3, 1102 of 3547) of men were medically circumcised (p<0·0001), and 45·6% (42·9-48·2, 1251 of 2955) of women and 36·7% (32·3-41·2, 341 of 1014) of men reported antiretroviral therapy (ART) use (p=0·0003). HIV viral suppression was achieved in 54·8% (52·0-57·5, 1574 of 2955) of women and 41·9% (37·1-46·7, 401 of 1014) of men (p<0·0001), and 87·2% (84·6-89·8, 1086 of 1251) of women and 83·9% (78·5-89·3, 284 of 341; p=0·3670) of men on ART. Age, incomplete secondary schooling, being single, having more than one lifetime sex partner (women), sexually transmitted infections, and not being medically circumcised were associated with HIV-positive status.InterpretationThe HIV burden in specific age groups, the suboptimal differential coverage, and uptake of HIV prevention strategies justifies a location-based approach to surveillance with finer disaggregation by age and sex. Intensified and customised approaches to seek, identify, and link individuals to HIV services are crucial to achieving epidemic control in this community.FundingThe President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.

Project description:BackgroundFinancing for NCDs is encumbered by out-of-pocket expenditure (OOPE) assuming catastrophic proportions. Therefore, it is imperative to investigate the extent of catastrophic health expenditure (CHE) on NCDs, which are burgeoning in India. Thus, our paper aims to examine the extent of CHE and impoverishment in India, in conjunction with socio-economic determinants impacting the CHE.MethodsWe used cross-sectional data from nationwide healthcare surveys conducted in 2014 and 2017-18. OOPE on both outpatient and inpatient treatment was coalesced to estimate CHE on NCDs. Incidence of CHE was defined as proportion of households with OOPE exceeding 10% of household expenditure. Intensity of catastrophe was ascertained by the measure of Overshoot and Mean Positive Overshoot Indices. Further, impoverishing effects of OOPE were assessed by computing Poverty Headcount Ratio and Poverty Gap Index using India's official poverty line. Concomitantly, we estimated the inequality in incidence and intensity of catastrophic payments using Concentration Indices. Additionally, we delineated the factors associated with catastrophic expenditure using Multinomial Logistic Regression.ResultsResults indicated enormous incidence of CHE with around two-third households with NCDs facing CHE. Incidence of CHE was concentrated amongst poor that further extended from 2014(CI = - 0.027) to 2017-18(CI = - 0.065). Intensity of CHE was colossal as households spent 42.8 and 34.9% beyond threshold in 2014 and 2017-18 respectively with poor enduring greater overshoot vis-à-vis rich (CI = - 0.18 in 2014 and CI = - 0.23 in 2017-18). Significant immiserating impact of NCDs was unraveled as one-twelfth in 2014 and one-eighth households in 2017-18 with NCD burden were pushed to poverty with poverty deepening effect to the magnitude of 27.7 and 30.1% among those already below poverty on account of NCDs in 2014 and 2017-18 respectively. Further, large inter-state heterogeneities in extent of CHE and impoverishment were found and multivariate analysis indicated absence of insurance cover, visiting private providers, residing in rural areas and belonging to poorest expenditure quintile were associated with increased likelihood of incurring CHE.ConclusionSubstantial proportion of households face CHE and subsequent impoverishment due to NCD related expenses. Concerted efforts are required to augment the financial risk protection to the households, especially in regions with higher burden of NCDs.

Dataset Information

Potential effect of household environment on prevalence of tuberculosis in India: evidence from the recent round of a cross-sectional survey.

Publications

Potential effect of household environment on prevalence of tuberculosis in India: evidence from the recent round of a cross-sectional survey.

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