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Higher loss of livelihood and impoverishment in households affected by tuberculosis compared to non-tuberculosis affected households in Zimbabwe: A cross-sectional study

Author

Listed:
  • Collins Timire
  • Rein M G J Houben
  • Debora Pedrazzoli
  • Rashida A Ferrand
  • Claire J Calderwood
  • Virginia Bond
  • Fredrick Mbiba
  • Katharina Kranzer

Abstract

Tuberculosis (TB) disproportionally affects poor people, leading to income and non-income losses. Measures of socioeconomic impact of TB, e.g. impoverishment and patient costs are inadequate to capture non-income losses. We applied impoverishment and a multidimensional measure on TB and non-TB affected households in Zimbabwe. We conducted a cross-sectional study in 270 households: 90 non-TB; 90 drug-susceptible TB (DS-TB), 90 drug-resistant TB (DR-TB) during the COVID-19 pandemic (2020–2021). Household data included ownership of assets, number of household members, income and indicators on five capital assets: financial, human, social, natural and physical. Households with incomes per capita below US$1.90/day were considered impoverished. We used principal component analysis on five capital asset indicators to create a binary outcome variable indicating loss of livelihood. Log-binomial regression was used to determine associations between loss of livelihood and type of household. TB-affected households were more likely to report episodes of TB and household members requiring care than non-TB households. The proportions of impoverished households were 81% (non-TB), 88% (DS-TB) and 94% (DR-TB) by the time of interview. Overall, 56% (152/270) of households sold assets: 44% (40/90) non-TB, 58% (52/90) DS-TB and 67% (60/90) DR-TB. Children’s education was affected in 33% (55/168) of TB-affected compared to 14% (12/88) non-TB households. Overall, 133 (50%) households experienced loss of livelihood, with TB-affected households almost twice as likely to experience loss of livelihood; adjusted prevalence ratio (aPR = 1.78 [95%CI:1.09–2.89]). The effect of TB on livelihood was most pronounced in poorest households (aPR = 2.61, [95%CI:1.47–4.61]). TB-affected households experienced greater socioeconomic losses compared to non-TB households. Multisectoral social protection is crucial to mitigate impacts of TB and other shocks, especially targeting poorest households.

Suggested Citation

  • Collins Timire & Rein M G J Houben & Debora Pedrazzoli & Rashida A Ferrand & Claire J Calderwood & Virginia Bond & Fredrick Mbiba & Katharina Kranzer, 2024. "Higher loss of livelihood and impoverishment in households affected by tuberculosis compared to non-tuberculosis affected households in Zimbabwe: A cross-sectional study," PLOS Global Public Health, Public Library of Science, vol. 4(6), pages 1-16, June.
    • Handle: RePEc:plo:pgph00:0002745
    DOI: 10.1371/journal.pgph.0002745
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    References listed on IDEAS

    as
    1. Quandt, Amy, 2018. "Measuring livelihood resilience: The Household Livelihood Resilience Approach (HLRA)," World Development, Elsevier, vol. 107(C), pages 253-263.
    2. Sweeney, Sedona & Mukora, Rachel & Candfield, Sophie & Guinness, Lorna & Grant, Alison D. & Vassall, Anna, 2018. "Measuring income for catastrophic cost estimates: Limitations and policy implications of current approaches," Social Science & Medicine, Elsevier, vol. 215(C), pages 7-15.
    3. Rebecca Tadokera & Stella Huo & Grant Theron & Collins Timire & Salome Manyau-Makumbirofa & John Z Metcalfe, 2021. "Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study," PLOS ONE, Public Library of Science, vol. 16(7), pages 1-12, July.
    4. Carole Rakodi, 1999. "A Capital Assets Framework for Analysing Household Livelihood Strategies: Implications for Policy," Development Policy Review, Overseas Development Institute, vol. 17(3), pages 315-342, September.
    5. repec:iwt:bosers:h032821 is not listed on IDEAS
    6. Collins Timire & Charles Sandy & Rashida A Ferrand & Regina Mubau & Peter Shiri & Obert Mbiriyawanda & Fredrick Mbiba & Rein M G J Houben & Debora Pedrazzoli & Virginia Bond & Nicola Foster & Katharin, 2022. "Coverage and effectiveness of conditional cash transfer for people with drug resistant tuberculosis in Zimbabwe: A mixed methods study," PLOS Global Public Health, Public Library of Science, vol. 2(12), pages 1-18, December.
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