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Assessment of the Syndemic Relationship Between Individual, Social, and Structural Determinants of Tuberculosis Among People Living in Johannesburg, South Africa

Author

Listed:
  • Fiona Tsungirai Tanyanyiwa

    (Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2006, South Africa)

  • Renay Helouise Van Wyk

    (Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2006, South Africa)

  • Keitshepile Geoffrey Setswe

    (Implementation Research Division, Aurum Institute, Johannesburg 2193, South Africa
    Department of Health Studies, University of South Africa, Pretoria 0003, South Africa)

Abstract

Tuberculosis (TB) remains a critical public health issue in Johannesburg, South Africa, driven by a complex interplay of individual, social, and structural factors. This study assessed the syndemic relationship between these determinants to understand their collective impact on TB burden and treatment outcomes. A cross-sectional survey was conducted among TB patients attending selected clinics, examining behavioural risks (e.g., smoking, alcohol use, HIV co-infection), social conditions (poverty, overcrowding, stigma), and structural challenges (access to healthcare, migration status). The results revealed a significant co-occurrence of TB and HIV (56.1%), alongside high rates of smoking (33.1%) and alcohol use (45.2%). Unemployment (50.2%), inadequate housing, and limited healthcare access, particularly for undocumented migrants (26.2%), were also prominent. Factor analysis demonstrated a syndemic interaction between behavioural and social determinants, underscoring the compounded vulnerability of affected populations. The findings highlight the necessity of integrating medical interventions with social and structural reforms. Recommendations include TB-HIV co-management, substance abuse programmes, improved housing, and inclusive healthcare access. A multisectoral approach addressing both health and socioeconomic inequalities is critical for comprehensive TB control in urban South African contexts.

Suggested Citation

  • Fiona Tsungirai Tanyanyiwa & Renay Helouise Van Wyk & Keitshepile Geoffrey Setswe, 2025. "Assessment of the Syndemic Relationship Between Individual, Social, and Structural Determinants of Tuberculosis Among People Living in Johannesburg, South Africa," IJERPH, MDPI, vol. 22(8), pages 1-15, August.
    • Handle: RePEc:gam:jijerp:v:22:y:2025:i:8:p:1272-:d:1724476
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    References listed on IDEAS

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    1. Hargreaves, J.R. & Boccia, D. & Evans, C.A. & Adato, M. & Petticrew, M. & Porter, J.D., 2011. "The social determinants of tuberculosis: from evidence to action," American Journal of Public Health, American Public Health Association, vol. 101(4), pages 654-662.
    2. Lönnroth, Knut & Jaramillo, Ernesto & Williams, Brian G. & Dye, Christopher & Raviglione, Mario, 2009. "Drivers of tuberculosis epidemics: The role of risk factors and social determinants," Social Science & Medicine, Elsevier, vol. 68(12), pages 2240-2246, June.
    3. Harling, Guy & Ehrlich, Rodney & Myer, Landon, 2008. "The social epidemiology of tuberculosis in South Africa: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 66(2), pages 492-505, January.
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