2023-09-28 14:46:10 +00:00
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abstract: 'Background
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Mitigating the socioeconomic impact of tuberculosis (TB) is key to the
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WHO End TB Strategy. However, little known about socioeconomic
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well-being beyond TB-treatment completion. In this mixed-methods study,
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we describe socioeconomic outcomes after TB-disease in urban Blantyre,
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Malawi, and explore pathways and barriers to financial recovery.
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Methods
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Adults >= 15 years successfully completing treatment for a first episode
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of pulmonary TB under the National TB Control Programme were
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prospectively followed up for 12 months. Socioeconomic, income,
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occupation, health seeking and cost data were collected. Determinants
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and impacts of ongoing financial hardship were explored through illness
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narrative interviews with purposively selected participants.
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Results
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405 participants were recruited from February 2016 to April 2017. Median
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age was 35 years (IQR: 28-41), 67.9\% (275/405) were male, and 60.6\%
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(244/405) were HIV-positive. Employment and incomes were lowest at
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TB-treatment completion, with limited recovery in the following year:
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fewer people were in paid work (63.0\% (232/368) vs 72.4\% (293/405),
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p=0.006), median incomes were lower (US\$44.13 (IQR: US\$0-US\$106.15)
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vs US\$72.20 (IQR: US\$26.71-US\$173.29), p<0.001), and more patients
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were living in poverty (earning <US\$1.90/day: 57.7\% (211/366) vs
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41.6\% (166/399), p<0.001) 1 year after TB-treatment completion compared
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with before TB-disease onset. Half of the participants (50.5\%, 184/368)
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reported ongoing dissaving (use of savings, selling assets, borrowing
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money) and 9.5\% (35/368) reported school interruptions in the year
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after TB-treatment completion. Twenty-one participants completed
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in-depth interviews. Reported barriers to economic recovery included
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financial insecurity, challenges rebuilding business relationships,
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residual physical morbidity and stigma.
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Conclusions
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TB-affected households remain economically vulnerable even after
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TB-treatment completion, with limited recovery in income and employment,
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persistent financial strain requiring dissaving, and ongoing school
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interruptions. Measures of the economic impact of TB disease should
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include the post-TB period. Interventions to protect the long-term
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health and livelihoods of TB survivors must be explored.'
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affiliation: 'Meghji, J (Corresponding Author), Univ Liverpool Liverpool Sch Trop
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Med, Dept Clin Sci, Liverpool, Merseyside, England.
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Meghji, Jamilah; Gregorius, Stefanie; Thomson, Rachael; Rylance, Jamie; Gordon,
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Stephen B.; Mortimer, Kevin; Squire, Stephen Bertel, Univ Liverpool Liverpool Sch
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Trop Med, Dept Clin Sci, Liverpool, Merseyside, England.
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Meghji, Jamilah; Chitimbe, Fatima; Rylance, Jamie; Gordon, Stephen B., Malawi Liverpool
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Wellcome Trust Clin Res Programm, Blantyre, Malawi.
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Gregorius, Stefanie, Deutsche Gesell Int Zusammenarbeit, Bonn, Germany.
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Madan, Jason, Univ Warwick, Warwick Clinical Trials Unit, Coventry, W Midlands,
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England.
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Banda, Ndaziona P. K., Queen Elizabeth Cent Hosp, Dept Med, Blantyre, Malawi.
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Corbett, Elizabeth L., London Sch Hyg \& Trop Med, Dept Infect \& Trop Dis, London,
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England.'
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author: Meghji, Jamilah and Gregorius, Stefanie and Madan, Jason and Chitimbe, Fatima
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and Thomson, Rachael and Rylance, Jamie and Banda, Ndaziona P. K. and Gordon, Stephen
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B. and Corbett, Elizabeth L. and Mortimer, Kevin and Squire, Stephen Bertel
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author-email: jamilah.meghji@lstmed.ac.uk
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author_list:
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- family: Meghji
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given: Jamilah
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- family: Gregorius
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given: Stefanie
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- family: Madan
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given: Jason
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- family: Chitimbe
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given: Fatima
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- family: Thomson
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given: Rachael
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- family: Rylance
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given: Jamie
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- family: Banda
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given: Ndaziona P. K.
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- family: Gordon
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given: Stephen B.
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- family: Corbett
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given: Elizabeth L.
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- family: Mortimer
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given: Kevin
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- family: Squire
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given: Stephen Bertel
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da: '2023-09-28'
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doi: 10.1136/thoraxjnl-2020-215338
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eissn: 1468-3296
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files: []
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issn: 0040-6376
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journal: THORAX
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keywords: 'Pulmonary tuberculosis; TB sequelae; post-TB lung disease; health
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economics; social determinants'
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keywords-plus: BURDEN; AFRICA; CARE
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language: English
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month: APR
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number: '4'
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number-of-cited-references: '28'
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orcid-numbers: 'Mortimer, Kevin/0000-0002-8118-8871
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Madan, Jason/0000-0003-4316-1480
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Rylance, Jamie/0000-0002-2323-3611
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Gordon, Stephen/0000-0001-6576-1116
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Meghji, Jamilah/0000-0002-4693-8884
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Corbett, Elizabeth/0000-0002-3552-3181
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Thomson, Rachael/0000-0001-5010-3428'
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pages: 387-395
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papis_id: 9b4c8dffadf212eb49f18c13f43b9052
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ref: Meghji2021longterm
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researcherid-numbers: 'Rylance, Jamie/ABD-9314-2021
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'
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times-cited: '16'
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title: The long term effect of pulmonary tuberculosis on income and employment in
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a low income, urban setting
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000631875900011
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usage-count-last-180-days: '2'
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usage-count-since-2013: '4'
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volume: '76'
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web-of-science-categories: Respiratory System
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year: '2021'
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