Increased Incidence of Tuberculosis in Zimbabwe, in Association with Food Insecurity, and Economic Collapse: An Ecological Analysis

PLoS One

Andrew Simor¹  Lovemore Katumbe²  R. D. Barker³  Michael Silverman³  Dan Schwarz⁴  Arif Jetha⁵  Stephen J. Burke⁶  Paul Thistle⁷  Elliot Lass⁷  Shelly Bolotin⁷ 

[1] Brigham and Women's Hospital and Children's Hospital of Boston, Boston, Massachusetts, United States of America;Karanda Hospital, Mount Darwin, Zimbabwe;The Dalla Lana School of Public Health, Toronto, Canada;The Howard Hospital, Glendale, Zimbabwe;The University of Zimbabwe, Harare, Zimbabwe;University of Ottawa, Ottawa, Canada;University of Toronto, Toronto, Canada

关键词: Tuberculosis;    HIV;    HIV epidemiology;    Zimbabwe;    Tuberculosis diagnosis and management;    Socioeconomic aspects of health;    Outpatients;    Seasons;   

DOI  :  10.1371/journal.pone.0083387

学科分类：医学（综合）

来源: Public Library of Science

【 摘 要 】

Background Zimbabwe underwent a socioeconomic crisis and resultant increase in food insecurity in 2008–9. The impact of the crisis on Tuberculosis (TB) incidence is unknown.Methods Prospective databases from two mission hospitals, which were geographically widely separated, and remained open during the crisis, were reviewed.Results At the Howard Hospital (HH) in northern Zimbabwe, TB incidence increased 35% in 2008 from baseline rates in 2003–2007 (p<0.01) and remained at that level in 2009. Murambinda Hospital (MH) in Eastern Zimbabwe also demonstrated a 29% rise in TB incidence from 2007 to 2008 (p<0.01) and remained at that level in 2009. Data collected post-crisis at HH showed a decrease of 33% in TB incidence between 2009 to 2010 (p<0.001) and 2010/2011 TB incidence remained below that of the crisis years of 2008/2009 (p<0.01). Antenatal clinic HIV seroprevalence at HH decreased between 2001(23%) to 2011(11%) (p<0.001). Seasonality of TB incidence was analyzed at both MH and HH. There was a higher TB incidence in the dry season when food is least available (September-November) compared to post harvest (April-June) (p<0.001).Conclusion This study suggests that an epidemic of TB mirrored socioeconomic collapse and recovery in Zimbabwe. The seasonal data suggests that food security may have been associated with TB incidence both annually and during the crisis in this high HIV prevalence country.

【 授权许可】

CC BY