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].