Distal Factors
Socioeconomic Status
Overall, 648 (62%) of households were classified as of low SES. When
examined by monthly income, 59% of caregivers earned less than $68,
38% earned between $68 - 340 and 3% earned more than $340 per month
[Table II]. Socio-economic status was measured in several ways,
caregiver monthly income was associated with differences in childhood TB
status (p=0.003); as was caregiver educational attainment of less than
10 years (p=0.010) [Table II]. Both relationships remained
significant in the unadjusted model for PTB in children. Monthly income
was not included in multivariate analyses due to missing data. Inclusion
of this measure did not impact findings in supplementary analyses. In
the univariate analyses monthly income below $68 USD and educational
attainment below 10 years were also associated with microbiologically
confirmed TB [Table V]. Low SES remained statistically significant
in the multivariate analyses for children with microbiologically
confirmed PTB (p=0.036), further highlighting the importance of this
distal risk factor.
Nutritional Status
Nutritional status was looked at in two ways. First, it was used as a
proxy for food insecurity to explore the impact of this distal factor on
PTB. Second, it was used as an outcome variable to look at patterns
between TB determinants and risk factors related to TB . Among children
with malnutrition, suboptimal nutritional status, defined as
weight-for-age <-3 was associated with the following child
characteristics: younger age (p = 0.016), HIV infection (p = 0.001),
hospitalization (p <0.001) and the following caregiver
characteristics: less than 10 years of schooling (p = 0.005), HIV
infection (p=0.008), smoking (p <0.001) and severe
psychological distress, (p = 0.028). In a multivariate logistic
regression model, child HIV-infection (p <0.001),
hospitalization (p = 0.018), caregiver active smoking (p
<0.001) and caregiver with severe psychological distress (p =
0.015) were independently associated with childhood malnutrition
[Table IV].