Globalization and life lost due to tuberculosis: evidence from a multi-country study

Background: Tuberculosis affects around 30% of the population of the world. Tuberculosis causes an increase in early mortality and thus has the potential to increase the number of years of life lost. Globalization directly or indirectly by affecting the factors that increase the susceptibility for tuberculosis infection has the potential to increase the spread and mortality due to tuberculosis. This study assessed the causal link between globalization and the years of life lost due to tuberculosis. Methods: Data from the Demographic and Health Survey (DHS) and World Bank for 2004 and 2005 were used for a number of covariates and possible mediators. Data from the Institute of Health Metrics and Evaluation (IHME) were used for the outcome variable and important globalization indicators. The primary health outcome that was studied is tuberculosis and the measure that was used to quantify tuberculosis mortality is the years of life lost (YLL). Path analysis was used. Results: The main independent variables of economic and social integration were not statistically significant. For every unit increase in the proportion of people that were using treated drinking water, there was a -0.0002 decrease in the YLL due to tuberculosis. For every unit increase in the proportion of people with earth floor, there was a 0.0002 units increase in YLL due to tuberculosis. For every unit increase in the proportion of people living using clean fuel, there was a 0.0004 decrease in the YLL due to tuberculosis. Conclusions: Social and economic globalization have no effect on the years of life lost due to tuberculosis, highlighting that globalization actually does not contribute to tuberculosis mortality. However, improving other important determinants such as sanitation, providing safe drinking water and clean households will reduce the mortality due to tuberculosis, highlighting the need to invest in them.

Characterisation of tuberculosis mortality in informal settlements in Nairobi, Kenya: analysis of data between 2002 and 2016

Background Tuberculosis (TB) remains one of the key public health problems in Africa. Due to multifaceted challenges, its burden is poorly described in informal settlements. We describe tuberculosis mortality in two informal settlements in Nairobi, Kenya. Methods This is a secondary analysis of 2002–2016 verbal autopsy data from informal settlements in the Nairobi Urban Health Demographic Surveillance System (NUHDSS). A descriptive analysis of deaths assigned as caused by TB was done. Pearson chi-square tests were used to determine differences between socio-demographic factors. Logistic regression was carried out to examine the risk of death from TB within the characteristics. Results There were 6218 deaths in the NUHDSS within the period of analysis, of which 930 (14.96%) were deaths from TB. The average number of TB deaths per year was 62(SD 23.9). There was a reduction in TB deaths from 21.2% in 2005 to 1.7% in 2016. Males had 1.39 higher odds of dying from TB than females (AOR 1.39; 95% CI 1.18–1.64; p-value < 0.001). Compared to those aged 30–39 years, the ≥50-year-olds had a 42% lower chance of dying from TB (AOR 0.57; 95% CI 0.47–0.73; p-value < 0.001). Those dying at home had 1.39 odds of dying from TB as compared to those who died in a health facility(AOR 1.93; 95% CI 1.17–1.64; p value< 0.001). Conclusion There was a reduction in TB deaths over the study period. Males had the highest risk of death. There is a need to strengthen TB surveillance and access to TB diagnosis and treatment within informal settlements to enhance early diagnosis and treatment.

Characterisation of Tuberculosis Mortality in Informal Settlements in Nairobi, Kenya: Analysis of Data Between 2002 and 2016

Background: Tuberculosis (TB) remains one of the key public health problems in Africa. Due to multifaceted challenges, its burden is poorly described in informal settlements. We describe tuberculosis mortality in informal settlements of Nairobi, Kenya. Methods: This is a secondary analysis of 2002-2016 verbal autopsy data from the Nairobi Urban Health Demographic Surveillance System (NUHDSS). A descriptive analysis of deaths assigned as caused by TB was done. Pearson chi-square tests were used to determine differences between background characteristics. Logistic regression was carried out to examine the risk of death from TB within the background characteristics.Results: There were 6,218 deaths in the NUHDSS within the period of analysis, of which 930 (14.96 %) were deaths from TB. There was a downward trend of TB deaths while the average number of TB deaths per year was 62(SD 23.9). Males had 1.39 higher odds of dying from TB than females (AOR 1.39; 95% CI 1.18-1.64; p-value <0.001). Compared to those aged 30-39 years, the ≥50-year-olds had a 42 % lower chance of dying from TB (AOR 0.57; 95% CI 0.47-0.73; p-value <0.001). Those dying at home had 1.39 odds of dying from TB as compared to those who died in a health facility(AOR 1.93; 95% CI 1.17-1.64; p value<0.001).Conclusion: There was a reduction in TB deaths over the study period. Males had the highest risk of death. There is a need to strengthen TB surveillance and access to TB diagnosis and treatment within informal settlements to enhance early diagnosis and treatment.