Major depression and household food insecurity among individuals with multidrug-resistant tuberculosis (MDR-TB) in South Africa

Andrew Tomita,Jonathan K Burns,Suvira Ramlall,Nesri Padayatchi,Sbusisiwe Sandra Mthembu,Thirusha Naidu

doi:10.1007/s00127-019-01669-y

Abstract

PurposeHousehold food insecurity in South Africa is a pervasive public health challenge. Although its link to chronic health conditions is well established, its relationship to mental illness, particularly major depression, is not well-understood. Despite KwaZulu-Natal Province being the epicenter of the drug-resistant tuberculosis (MDR-TB) epidemic, and having the largest share of poverty in South Africa, this relationship remains unexamined. This study investigated the association between major depressive episode (MDE) and household food insecurity among individuals with MDR-TB.MethodsWe enrolled and interviewed 141 newly admitted microbiologically confirmed MDR-TB inpatients at a specialized TB hospital in KwaZulu-Natal Province, South Africa. Logistic regression models were fitted to assess the relationship between MDE and household food insecurity, while accounting for socio-demographic status (e.g., age, gender, education, marital status, social grant status, income, and preference for living in one’s community).ResultsThe prevalence of MDE and household food insecurity was 11.35% and 21.01%, respectively. MDE was significantly associated with household food insecurity (aOR 4.63, 95% CI 1.17–18.38). Individuals who are female (aOR 6.29, 95% CI 1.13–35.03), young (aOR 8.86, 95% CI 1.69–46.34), have low educational attainment (aOR 6.19, 95% CI 1.70–22.59) and receive social grants (aOR 7.60, 95% CI 2.36–24.48) were most at risk of household food insecurity.ConclusionsMDE in individuals with MDR-TB was significantly associated with household food insecurity, independent of socio-economic status. Although MDR-TB is not exclusively a disease of the poor, individuals from socio-economically disadvantaged backgrounds (e.g., female, young adults, low education, and social grant recipients) were more likely to experience household food insecurity. Our study underscores the need to address the co-occurring cycles of food insecurity and untreated MDE in South Africa.

Highlights

Despite the political advances in South Africa since the transition to democracy, there has been little progress in addressing household food insecurity (21.3% in 2017 versus 21.2% in 2011 [1])
Food insecurity is a quintessential symbol of poverty, with an increasing proportion of South Africans living under the food poverty line (25.2% in 2015 versus 21.4% in 2011 [7])
We investigated the role of major depressive episode (MDE) in household food insecurity among individuals with multidrug-resistant tuberculosis (MDR-TB) in KZN

Summary

Introduction

Despite the political advances in South Africa since the transition to democracy, there has been little progress in addressing household food insecurity (21.3% in 2017 versus 21.2% in 2011 [1]). Food insecurity is a quintessential symbol of poverty, with an increasing proportion of South Africans living under the food poverty line (25.2% in 2015 versus 21.4% in 2011 [7]). Many households continue to experience severe food inadequacy, standing at 4.8% (in 2017) [1], while 34.3% (in 2015) [7] live under the food poverty line. Tuberculosis (TB), with 380 new cases per 1000 in 2016, is the leading cause of death in South Africa [11], and can be marginalizing, with numerous social and health consequences. Incidence rates of TB and multidrug-resistant tuberculosis (MDR-TB) are 567 (includes HIV + TB) and 25 per 100,000 population, respectively [16], with the disease accounting for the largest percentage of total mortality in 2016 (6.5%) in South Africa [17]. In KZN, the prevalence of MDR-TB was 2.9% during 2012–2014 [21], and continues to be a major public health challenge

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