{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:30:40Z","timestamp":1768566640990,"version":"3.49.0"},"posted":{"date-parts":[[2023,12,5]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":62,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2023,12,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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. We determined proportions of impoverished households for periods 12 months prior and at the time of the interview. Households with incomes below US$1.90\/day were considered to be 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.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>TB-affected households reported higher previous episodes of TB and household members requiring care than non-TB households. Households that were impoverished 12 months prior to the study were: 21 non-TB (23%); 40 DS-TB (45%); 37 DR-TB (41%). The proportions increased to 81%, 88% and 94%, respectively 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\u2019s education was affected in 31% (56\/180) of TB-affected compared to 13% (12\/90) non-TB households. Overall, 133(50%) households experienced loss of livelihood, with TB-affected households twice as likely to experience loss of livelihood; adjusted prevalence ratio (aPR=2.02 (95%CI:1.35-3.03)). The effect of TB on livelihood was most pronounced in poorest households (aPR=2.64, (95%CI:1.29-5.41)).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>TB-affected households experienced greater socioeconomic losses compared to non-TB households. Multidimensional measures of TB are crucial to inform multisectoral approaches to mitigate impacts of TB and other shocks.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2023.12.05.23299470","type":"posted-content","created":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T02:05:15Z","timestamp":1701828315000},"source":"Crossref","is-referenced-by-count":0,"title":["Higher loss of livelihood and impoverishment in households affected by tuberculosis compared to non-tuberculosis affected households in Zimbabwe: a cross-sectional study"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0997-9799","authenticated-orcid":false,"given":"Collins","family":"Timire","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4132-7467","authenticated-orcid":false,"given":"Rein MGJ","family":"Houben","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6434-4457","authenticated-orcid":false,"given":"Debora","family":"Pedrazzoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7660-9176","authenticated-orcid":false,"given":"Rashida Abbas","family":"Ferrand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1926-7464","authenticated-orcid":false,"given":"Claire J","family":"Calderwood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6815-4239","authenticated-orcid":false,"given":"Virginia","family":"Bond","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1666-2979","authenticated-orcid":false,"given":"Fredrick","family":"Mbiba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5691-7270","authenticated-orcid":false,"given":"Katharina","family":"Kranzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2023120818101547000_2023.12.05.23299470v1.1","unstructured":"University Research Co. LLC, \u201cProviding Comprehensive Patient-Centred Care: A conceptual framework for social support for TB patients,\u201d Bethesda, USA, 2014. [Online]. Available: www.urc-chs.com\/sites\/default\/files\/ProvidingComprehensiveCare.pdf."},{"key":"2023120818101547000_2023.12.05.23299470v1.2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01877-2016"},{"key":"2023120818101547000_2023.12.05.23299470v1.3","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.13647"},{"key":"2023120818101547000_2023.12.05.23299470v1.4","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.13085"},{"key":"2023120818101547000_2023.12.05.23299470v1.5","doi-asserted-by":"publisher","DOI":"10.1186\/s40249-017-0382-3"},{"issue":"21","key":"2023120818101547000_2023.12.05.23299470v1.6","first-page":"1","article-title":"Household catastrophic payments for tuberculosis care in Nigeria : incidence, determinants, and policy implications for universal health coverage","volume":"2","year":"2013","journal-title":"Infect. 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