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Tuberculosis Infection in Zambia: The Association with Relative Wealth

This study aimed to assess the association between household socioeconomic position and tuberculosis (TB) infection in two communities of Zambia. For this purpose we implemented a cross-sectional investigation, nested within a larger case control study. Infection was assessed using Quantiferon-TB Gold. A socioeconomic position index was constructed through principal component analysis combining data on human resources, food availability, housing quality, and access to services and infrastructures. In this study, higher socioeconomic position, rather than lower, was associated with significantly higher risk of TB infection. None of the traditional risk factors for TB infection mediated this association, suggesting that in these two communities TB transmission may occur through exposure to as yet undefined risk factors that are associated with higher socioeconomic position. Although further studies are needed, these results suggest emerging new patterns of TB transmission and a role of socioeconomic position on the risk of TB infection opposite to that expected.

Received October 3, 2008. Accepted for publication February 3, 2009.

^* Address correspondence to Delia Boccia, Infectious Diseases Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom. E-mail: delia.boccia{at}lshtm.ac.uk

Authors’ addresses: Delia Boccia, Infectious Diseases Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1 E7HT, United Kingdom, Tel: +44(0)20-7958-8145, Fax: +44(0)20-7612-7860, E-mail: delia.boccia{at}lshtm.ac.uk. James Hargreaves, Infectious Diseases Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, Tel: +44(0)20-7927-2955, Fax: +44(0)20-7612-7860, E-mail: james.hargreaves{at}lshtm.ac.uk. Helen Ayles, Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia, Tel: +260-1-254710, Fax: +260-1-254710, E-mail: helen{at}zambart.org.zm. Ka therine Fielding, Infectious Diseases Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, Tel: +44(0)20-7927-2889, Fax: +44(0)20-7636-8739, E-mail: katherine.fielding{at}lshtm.ac.uk. Musonda Simwinga, ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia, Tel: +260-1-254710, Fax: +260-1-254710, E-mail: musonda{at}zambart.org.zm. Peter Godfrey-Faussett, Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, Tel: +44(0)20-7958-8127, Fax: +44(0)20-7612-7860, E-mail: peter.godfrey-faussett{at}lshtm.ac.uk.