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Vicious cycles of Poverty and TB

By Norah Owaraga, Managing Director of CPAR Uganda Ltd

Tuberculosis (TB) and poverty are bedfellows. It is paramount, therefore, that in fighting TB one necessarily cannot ignore poverty; and in fighting poverty one cannot afford to ignore TB. This is particularly so in the context of the 22 TB high disease burden countries (HDC), of which Uganda, Kenya and Tanzania are among. 

Professor Christopher Garimoi Orach emphasised the link between TB and poverty during a presentation that he made on 1st July 2016 at the Tuberculosis: Working to Empower Nations’ Diagnostic Efforts (TWENDE) Project Launch Conference that was held at the Nelson Mandela African Institution of Science and Technology.

The vicious cycle of poverty goes: one is poor – cannot afford medical care – tested late, if at all – unable to afford medicine or to go to and from the facilities with medicine – does not complete medication – develops multi drug resistant TB – ill health affects ability to work – loses a job – even when cured may not get job back due to stigma, employers my chose not to hire TB patient, past or present – without a job, no steady income – without steady income, unable to afford balanced diet – when one is malnourished the risk of TB is increased – and the cycle continues.

Similarly, when one is malnourished and gets infected with TB or vice versa, one’s productivity as a farmer is negatively affected – may not be able to produce sufficient food all year round – thus will likely be continuously underfed – leading to malnutrition - and the cycle continues.

A study conducted in Kampala, Uganda indeed confirmed poverty as among the TB risk factors. Of the TB patients who participated in the Kampala study, 39.5 percent were classified poor. Other risk factors that the Kampala study confirmed among its participants – TB patients, some which are associated with poverty, are: 

  • Overcrowding (in living and working conditions) – 57.3 percent
  • Alcohol use – 50.7 percent
  • HIV – 41.4 percent
  • Smoking – 26.37 percent
  • Family history of TB - 17.5 percent
  • Close contact – 11.5 percent
  • Diabetes - 5.4 percent

Prof. Orach’s presentation concurred with the conclusion of the Kampala study that sadly, aside from HIV the other TB risk factors, including poverty, are poorly studied in Uganda. There is no doubt that there is an association between TB prevalence and poverty levels. 

An important justification indeed for the ongoing TWENDE Research Project, for it will look into the social-cultural aspects which are impeding up-take of well researched TB diagnostics and treatments - TWENDE’s intention is to contribute towards breaking such vicious cycles of TB-poverty.