Social Determinants and Global TB Control

1. Air Pollution and TB Risk

• Household air pollutants (HAP), particularly PM2.5 and CO, from kerosene lighting and biomass cooking, elevate TB risk.
• PM2.5 exposure in study participants averaged 170 µg/m³, far exceeding WHO’s guideline of 25 µg/m³.
• Area PM2.5 significantly contributes to TB risk (OR 6.74), with kerosene lighting associated with increased odds (OR 3.73).
• PM exposure disrupts immune function and enhances M. tuberculosis growth, while NO2 exposure weakens host defenses.
• Reduction of air pollution is essential for TB prevention and control.

Intervention Plan: Implement a community-based program to distribute clean energy solutions (e.g., solar lighting and LPG stoves) to replace kerosene and biomass fuel. This program would also include education on proper ventilation and regular HAP monitoring to reduce PM2.5 exposure.

See also: Scholarships to Australia

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2. Nutrition and TB Dynamics

• Undernutrition is the leading risk factor for TB, impairing immunity and increasing susceptibility.
• Nutritional interventions reduce TB incidence and mortality, with a projected 23.6% reduction in TB incidence and a 35.5% decrease in mortality in high-risk populations when scaled.
• Historical case studies highlight the impact of improved nutrition on reducing TB rates during crises.
• Vitamin supplementation shows potential for TB prevention, particularly among high-risk family contacts.

Intervention Plan: Integrate nutritional support into TB care programs by providing monthly nutrient-rich food packages and micronutrient supplements to TB patients and their households. Monitor and adjust diets based on local nutritional deficiencies.

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3. Healthcare Systems and Diagnostic Gaps

• High-burden countries struggle with underinvestment, limited access to rapid molecular diagnostics, and case detection challenges.
• Only 38% of TB cases were tested using WHO-recommended diagnostics in 2021.
• Innovations like AI-assisted x-rays, oral swabs, and urine antigen tests face adoption barriers due to cost and infrastructure limitations.

Intervention Plan: Launch a mobile diagnostic initiative using AI-assisted chest x-rays and portable molecular diagnostic tools in underserved regions. Subsidize costs through public-private partnerships to improve early detection and reduce delays in TB diagnosis.

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4. Comorbidities and TB Risk

• TB-DM patients face higher metabolic disturbances, nutritional deficits, and cardiovascular risks.
• Poor glycemic control (HbA1c >10%) and vitamin D deficiency (73.68% in TB-DM group) exacerbate complications.
• Dialysis patients face elevated TB risks due to weakened immunity from oxidative stress and uremic toxins.

Intervention Plan: Develop a TB-DM management protocol that integrates glycemic control, regular vitamin D supplementation, and nutritional monitoring into existing healthcare services. Screen dialysis patients for TB risk and provide targeted prophylaxis.

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5. Social Determinants and Global TB Control

• Poverty, overcrowding, and poor living conditions are drivers of TB prevalence.
• Achieving the SDGs for TB requires sustained funding, equitable healthcare access, and addressing social determinants.
• Rapid mortality declines in some sub-Saharan African countries highlight the potential of focused interventions.

Intervention Plan: Introduce a conditional cash transfer program for TB-affected households to improve living conditions, reduce overcrowding, and provide access to healthcare. Combine this with public awareness campaigns to address stigma and encourage treatment adherence.

References:

1. Jagger, P., McCord, R., Gallerani, A., Hoffman, I., Jumbe, C., Pedit, J., Phiri, S., Krysiak, R. and Maleta, K., 2024. Household air pollution exposure and risk of tuberculosis: a case–control study of women in Lilongwe, Malawi. BMJ Public Health, 2(1).
2. Lu, J.W., Mao, J.J., Zhang, R.R., Li, C.H., Sun, Y., Xu, W.Q., Zhuang, X., Zhang, B. and Qin, G., 2023. Association between long-term exposure to ambient air pollutants and the risk of tuberculosis: A time-series study in Nantong, China. Heliyon, 9(6).
3. Reid, M., Agbassi, Y.J.P., Arinaminpathy, N., Bercasio, A., Bhargava, A., Bhargava, M., Bloom, A., Cattamanchi, A., Chaisson, R., Chin, D. and Churchyard, G., 2023. Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis. The Lancet, 402(10411), pp.1473-1498.
4. Furin, J., Cox, H., & Pai, M. (2019). Tuberculosis. Lancet (London, England), 393(10181), 1642–1656.
5. Mandal, S., Bhatia, V., Bhargava, A., Rijal, S. and Arinaminpathy, N., 2024. The potential impact on tuberculosis of interventions to reduce undernutrition in the WHO South-East Asian Region: a modelling analysis. The Lancet Regional Health-Southeast Asia, p.100423.
6. Cegielski, J.P. and McMurray, D.N., 2004. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. The international journal of tuberculosis and lung disease, 8(3), pp.286-298.
7. Shu, C.C., Hsu, C.L., Wei, Y.F., Lee, C.Y., Liou, H.H., Wu, V.C., Yang, F.J., Lin, H.H., Wang, J.Y., Chen, J.S. and Yu, C.J., 2016. Risk of tuberculosis among patients on dialysis: the predictive value of serial interferon-gamma release assay. Medicine, 95(22), p.e3813.
8. Patel, D.G., Baral, T., Kurian, S.J., Malakapogu, P., Saravu, K. and Miraj, S.S., 2024. Nutritional status in patients with tuberculosis and diabetes mellitus: A comparative observational study. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 35, p.100428.

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