• Melkianus Ratu Universitas Timor
Keywords: social Determinants, Tuberculosis, Developing countries


Background: The middle - income countries are the highest TB contributors in the world. The trigger for TB is not only identified from the medical aspect but is also related to social determinants of health. Literature review of relevant studies of social determinants of TB can contribute a more comprehensive understanding  than that obtained from individual studies alone. It can support the findings and interpretation of one study; describe differences or friction in the findings of the study; facilitate the emerging of new theories; and disseminate the design of new interventions.

Methods: The literature search was conducted using the databases of Google Scholar and Scopus. It was performed for a period of one week (12 th–19 th April, 2016). Inclusion criteria were: Articles were published in the period of 2001- 2016, the articles were written in English and studies were conducted in developing countries.

Results: Malnutrition, poverty, inadequate housing, educational status, urbanization, and unemployment were the themes emerging from the synthesis process.

Conclusions: There were six factors of social determinants of TB that emerged from this literature review. It includes poverty, inadequate housing, malnutrition, educational status, urbanization and unemployment. All the factors are strongly related and tend to have a combined effect as the social determinants of TB


Abdallah, TM & Ali, AAA 2012, 'Epidemiology of tuberculosis in Eastern Sudan', Asian Pacific journal of tropical biomedicine, vol. 2, no. 12, pp. 999-1001.

Acosta, LMW & Bassanesi, SL 2014, 'The porto alegre paradox: Social determinants and tuberculosis incidence', Revista Brasileira de Epidemiologia, vol. 17, pp. 88-101.

Aggarwal, AN 2010, 'Health-related quality of life: A neglected aspect of pulmonary tuberculosis', Lung India, vol. 27, no. 1, p. 1.

Amwayi, AS, Kikuvi, GM & Muchiri, EM 2010, 'Modifiable factors associated with active pulmonary tuberculosis in a Kenyan prison', East African medical journal, vol. 87, no. 2, pp. 43-8.

Arianna, AHR, MaríaTeresa, EM & Carlos, RLJ 2014, 'Risk of becoming Ill with pulmonary tuberculosis in Mexico', Biosciences Biotechnology Research Asia, vol. 11, no. 2, pp. 773-7.

Blas, E & Kurup, AS 2010, Equity, social determinants and public health programmes, World Health Organization.

Boccia, D, Hargreaves, J, De Stavola, BL, Fielding, K, Schaap, A, Godfrey-Faussett, P & Ayles, H 2011, 'The association between household socioeconomic position and prevalent tuberculosis in Zambia: a case-control study', PLoS ONE, vol. 6, no. 6, p. e20824.

Bonnefoy, X 2007, 'Inadequate housing and health: an overview', International Journal of Environment and Pollution, vol. 30, no. 3-4, pp. 411-29.

Borgdorff, MW, Floyd, K & Broekmans, JF 2002, 'Interventions to reduce tuberculosis mortality and transmission in low-and middle-income countries', Bulletin of the World Health Organization, vol. 80, no. 3, pp. 217-27.

Boutayeb, A 2006, 'The double burden of communicable and non-communicable diseases in developing countries', Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 100, no. 3, pp. 191-9.

Burke, F, Azam, M, Huda, S, Hamza, S & Haque, Q 2008, 'Quality of life and cause & effect relationship with resources and facilities-case study of selected towns in Karachi', Pakistan. J. Soc. Sci, vol. 5, pp. 268-79.

Cantwell, MF, Mckenna, MT, Mccray, E & Onorato, IM 1998, 'Tuberculosis and race/ethnicity in the United States: impact of socioeconomic status', American Journal of Respiratory and Critical Care Medicine, vol. 157, no. 4, pp. 1016-20.

Cegielski, J & McMurray, D 2004, 'The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals', The International Journal of Tuberculosis and Lung Disease, vol. 8, no. 3, pp. 286-98.

Chandra, RK 1991, '1990 l\/l0Collum Award Lecture. Nutrition and immunity: lessons from the past and new insights into the future'.

Coker, R, McKee, M, Atun, R, Dimitrova, B, Dodonova, E, Kuznetsov, S & Drobniewski, F 2006, 'Risk factors for pulmonary tuberculosis in Russia: case-control study', Bmj, vol. 332, no. 7533, pp. 85-7.

Cronin, P, Ryan, F & Coughlan, M 2008, 'Undertaking a literature review: a step-by-step approach'.

DePoy, E & Gitlin, LN 1994, Introduction to research: Multiple strategies for health and human services, Mosby.

Dye, C 2000, 'Tuberculosis 2000–2010: control, but not elimination [The Comstock Lecture]', The International Journal of Tuberculosis and Lung Disease, vol. 4, no. 12s2, pp. S146-S52.

Dye, C, Lönnroth, K, Jaramillo, E, Williams, B & Raviglione, M 2009, 'Trends in tuberculosis incidence and their determinants in 134 countries', Bulletin of the World Health Organization, vol. 87, no. 9, pp. 683-91.

Dye, C, Scheele, S, Dolin, P, Pathania, V & Raviglione, MC 1999, 'Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country', Jama, vol. 282, no. 7, pp. 677-86.

Egbagbe, EE, Okojie, OH & Amaize, E 2011, 'Epidemiology of pulmonary tuberculosis in University of Benin Teaching Hospital and Central Hospital, Benin City', Nigerian quarterly journal of hospital medicine, vol. 21, no. 2, pp. 159-62.

Firdaus, G & Ahmad, A 2013, 'Relationship between housing and health: A cross-sectional study of an urban centre of India', Indoor and Built Environment, vol. 22, no. 3, pp. 498-507.

Gehlbach, SH 1993, Interpreting the Medical Literature: Stephen H. Gehlbach, McGraw-Hill, Health Professions Division.

Gershwin, M 2012, Nutrition and immunity, Elsevier.

Gesesew, H, Tsehaineh, B, Massa, D, Tesfay, A, Kahsay, H & Mwanri, L 2016, 'The role of social determinants on tuberculosis/HIV co-infection mortality in southwest Ethiopia: A retrospective cohort study', BMC Research Notes, vol. 9, no. 1.

Green, BN, Johnson, CD & Adams, A 2006, 'Writing narrative literature reviews for peer-reviewed journals: secrets of the trade', Journal of chiropractic medicine, vol. 5, no. 3, pp. 101-17.

Gupta, KB, Gupta, R, Atreja, A, Verma, M & Vishvkarma, S 2009, 'Tuberculosis and nutrition', Lung India, vol. 26, no. 1, p. 9.

Gyawali, N, Gurung, R, Poudyal, N, Amatya, R, Niraula, SR, Jha, P & Bhattacharya, SK 2012, 'Prevalence of tuberculosis in household contacts of sputum smears positive cases and associated demographic risk factors', Nepal Medical College journal : NMCJ, vol. 14, no. 4, pp. 303-7.

Hargreaves, JR, Boccia, D, Evans, CA, Adato, M, Petticrew, M & Porter, JD 2011, 'The social determinants of tuberculosis: from evidence to action', American journal of public health, vol. 101, no. 4, pp. 654-62.

Harling, G & Castro, MC 2014, 'A spatial analysis of social and economic determinants of tuberculosis in Brazil', Health & place, vol. 25, pp. 56-67.

Harling, G, Ehrlich, R & Myer, L 2008, 'The social epidemiology of tuberculosis in South Africa: A multilevel analysis', Social Science and Medicine, vol. 66, no. 2, pp. 492-505.

Hawker, JI, Bakhshi, SS, Ali, S & Farrington, CP 1999, 'Ecological analysis of ethnic differences in relation between tuberculosis and poverty', Bmj, vol. 319, no. 7216, pp. 1031-4.

Hussain, A 2003, Poverty, Growth and Governance, Pakistan National Human Development Report 2003, UNDP, Oxford University Press, Karachi.

Hussain, H, Akhtar, S & Nanan, D 2003, 'Prevalence of and risk factors associated with Mycobacterium tuberculosis infection in prisoners, North West Frontier Province, Pakistan', International journal of epidemiology, vol. 32, no. 5, pp. 794-9.

Hutchison, B 1993, 'Critical appraisal of review articles', Canadian Family Physician, vol. 39, p. 1097.

Jackson, RJ 2003, 'The impact of the built environment on health: an emerging field', American journal of public health, vol. 93, no. 9, pp. 1382-4.

Jethani, S, Semwal, J, Kakkar, R & Rawat, J 2013, 'Study of epidemiological correlates of tuberculosis', Indian Journal of Community Health, vol. 24, no. 4, pp. 304-9.

Joosten, KF & Hulst, JM 2008, 'Prevalence of malnutrition in pediatric hospital patients', Current opinion in pediatrics, vol. 20, no. 5, pp. 590-6.

Jurcev-Savicevic, A, Mulic, R, Ban, B, Kozul, K, Bacun-Ivcek, L, Valic, J, Popijac-Cesar, G, Marinovic-Dunatov, S, Gotovac, M & Simunovic, A 2013, 'Risk factors for pulmonary tuberculosis in Croatia: a matched case–control study', BMC public health, vol. 13, no. 1, p. 1.

Kaulagekar, A & Radkar, A 2007, 'Social status makes a difference: tuberculosis scenario during National Family Health Survey-2', The Indian journal of tuberculosis, vol. 54, no. 1, pp. 17-23.

Khan, JA, Irfan, M, Zaki, A, Beg, M, Hussain, SF & Rizvi, N 2006, 'Knowledge, attitude and misconceptions regarding tuberculosis in Pakistani patients', Journal of Pakistan Medical Association, vol. 56, no. 5, p. 211.

Kiboss, JK & Kibitok, NK 2003, 'The re-emergence of tuberculosis among the economically productive age group in Kenya: The case of Mombasa district', Journal of Social Development in Africa, vol. 18, no. 2, pp. 121-32.

Kibret, KT, Yalew, AW, Belaineh, BG & Asres, MM 2013, 'Determinant factors associated with occurrence of tuberculosis among adult people living with HIV after antiretroviral treatment initiation in Addis Ababa, Ethiopia: a case control study', PLoS ONE, vol. 8, no. 5, p. e64488.

Kitchenham, B 2004, 'Procedures for performing systematic reviews', Keele, UK, Keele University, vol. 33, no. 2004, pp. 1-26.

Kjellstrom, T, Friel, S, Mercado, S, Havemann, K & Sattherthwaite, D 2007, 'Our cities our health our future. Acting on social determinants for health equity in urban settings. Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings'.

Ladefoged, K, Rendal, T, Skifte, T, Andersson, M, Søborg, B & Koch, A 2011, 'Risk factors for tuberculosis in Greenland: case-control study', The International Journal of Tuberculosis and Lung Disease, vol. 15, no. 1, pp. 44-9.

Lawn, SD 2000, 'Tuberculosis in Ghana: social stigma and compliance with treatment', International Journal of Tuberculosis and Lung Disease, vol. 4, no. 12, pp. 1190-2.

Lönnroth, K, Castro, KG, Chakaya, JM, Chauhan, LS, Floyd, K, Glaziou, P & Raviglione, MC 2010, 'Tuberculosis control and elimination 2010–50: cure, care, and social development', The Lancet, vol. 375, no. 9728, pp. 1814-29.

Lönnroth, K, Zignol, M & Uplekar, M 2006, 'Controlling TB in large metropolitan settings', TB: a comprehensive international approach. New York, Informa Healthcare.

Lowry, S 1991, 'Housing and Health (British Medical Journal, London)'.

Machado, ACdFT, Steffen, RE, Oxlade, O, Menzies, D, Kritski, A & Trajman, A 2011, 'Factors associated with delayed diagnosis of pulmonary tuberculosis in the state of Rio de Janeiro, Brazil', Jornal Brasileiro de Pneumologia, vol. 37, no. 4, pp. 512-20.

Magarey, A, Rogers, WA & Veale, BM 2000, An Anthology of Literature Reviews by GPEP Researchers, National Information Service, Department of General Practice, Flinders University of South Australia.

Marais, B, Hesseling, A & Cotton, M 2009, 'Poverty and tuberculosis: is it truly a simple inverse linear correlation?', European Respiratory Journal, vol. 33, no. 4, pp. 943-4.

Marais, B, Obihara, C, Warren, R, Schaaf, H, Gie, R & Donald, P 2005, 'The burden of childhood tuberculosis: a public health perspective [Review Article]', The International Journal of Tuberculosis and Lung Disease, vol. 9, no. 12, pp. 1305-13.

McFadden, P, Taylor, BJ, Campbell, A & McQuilkin, J 2012, 'Systematically identifying relevant research case study on child protection social workers’ resilience', Research on Social Work Practice, vol. 22, no. 6, pp. 626-36.

Meijers, JM, Schols, JM, Soeters, PB & Halfens, RJ 2010, 'Defining malnutrition: Mission or mission impossible?', Nutrition, vol. 26, no. 4, pp. 432-40.

Menzies, D, Joshi, R & Pai, M 2007, 'Risk of tuberculosis infection and disease associated with work in health care settings [State of the Art Series. Occupational lung disease in high-and low-income countries, Edited by M. Chan-Yeung. Number 5 in the series]', The International Journal of Tuberculosis and Lung Disease, vol. 11, no. 6, pp. 593-605.

Miandad, M, Burke, F, Nawaz-ul-Huda, S & Azam, M 2015, 'Geodemographic analysis of tuberculosis patients in Karachi, Pakistan', Human Geographies--Journal of Studies & Research in Human Geography, vol. 9, no. 2.

Muniyandi, M & Ramachandran, R 2008, 'Socioeconomic inequalities of tuberculosis in India', Expert opinion on pharmacotherapy, vol. 9, no. 10, pp. 1623-8.

Munro, SA, Lewin, SA, Smith, HJ, Engel, ME, Fretheim, A & Volmink, J 2007, 'Patient adherence to tuberculosis treatment: a systematic review of qualitative research', PLoS Med, vol. 4, no. 7, p. e238.

Myers, WP, Westenhouse, JL, Flood, J & Riley, LW 2006, 'An ecological study of tuberculosis transmission in California', American journal of public health, vol. 96, no. 4, pp. 685-90.

Odone, A, Crampin, AC, Mwinuka, V, Malema, S, Mwaungulu, JN, Munthali, L & Glynn, JR 2013, 'Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi', PLoS ONE, vol. 8, no. 10, p. e77740.

Oxlade, O & Murray, M 2012, 'Tuberculosis and poverty: why are the poor at greater risk in India?', PLoS ONE, vol. 7, no. 11, p. e47533.

Oxman, AD 1994, 'Checklists for review articles', BMJ: British Medical Journal, vol. 309, no. 6955, p. 648.

Oxman, AD & Guyatt, GH 1988, 'Guidelines for reading literature reviews', CMAJ: Canadian Medical Association journal, vol. 138, no. 8, p. 697.

Ploubidis, GB, Palmer, MJ, Blackmore, C, Lim, T-A, Manissero, D, Sandgren, A & Semenza, JC 2012, 'Social determinants of tuberculosis in Europe: a prospective ecological study', European Respiratory Journal, vol. 40, no. 4, pp. 925-30.

Przybylski, G, Dąbrowska, A, Pilaczyńska-Cemel, M & Krawiecka, D 2014, 'Unemployment in TB Patients–Ten-Year Observation at Regional Center of Pulmonology in Bydgoszcz, Poland', Medical science monitor: international medical journal of experimental and clinical research, vol. 20, p. 2125.

Ramachandran, R, Indu, P, Anish, T, Nair, S, Lawrence, T & Rajasi, R 2011, 'Determinants of childhood tuberculosis–a case control study among children registered under revised National Tuberculosis Control Programme in a district of South India', Indian J Tuberc, vol. 58, no. 4, pp. 204-7.

Rieder, HL 1999, Epidemiologic basis of tuberculosis control, International Union Against Tuberculosis and Lung Disease (IUATLD).

Rodrigues, LC & Smith, PG 1990, 'Tuberculosis in developing countries and methods for its control', Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 84, no. 5, pp. 739-44.

Romaszko, J, Buciński, A, Wasiński, R, Rosłan, A & Bednarski, K 2008, 'Incidence and risk factors for pulmonary tuberculosis among the poor in the northern region of Poland', The International Journal of Tuberculosis and Lung Disease, vol. 12, no. 4, pp. 430-5.

Rook, G & Hernandez-Pando, R 1996, 'The pathogenesis of tuberculosis', Annual Reviews in Microbiology, vol. 50, no. 1, pp. 259-84.

Ruxin, J, Paluzzi, JE, Wilson, PA, Tozan, Y, Kruk, M & Teklehaimanot, A 2005, 'Emerging consensus in HIV/AIDS, malaria, tuberculosis, and access to essential medicines', The Lancet, vol. 365, no. 9459, pp. 618-21.

Shafee, M, Abbas, F, Ashraf, M, Mengal, MA, Kakar, N, Ahmad, Z & Ali, F 2013, 'Hematological profile and risk factors associated with pulmonary tuberculosis patients in Quetta, Pakistan', Pakistan Journal of Medical Sciences, vol. 30, no. 1.

Sial, MH, Ashraf, G, Sarwar, G & Hassan, N 'Socio-economic determinants of incidence of tuberculosis in Sargodha District, Pakistan'.

Slavin, RE 1995, 'Best evidence synthesis: an intelligent alternative to meta-analysis', Journal of clinical epidemiology, vol. 48, no. 1, pp. 9-18.

Spence, D, Hotchkiss, J, Williams, C & Davies, P 1993, 'Tuberculosis and poverty', Bmj, vol. 307, no. 6907, pp. 759-61.

Taher-Ghasemi, Y, Nikokar, I, Yazdanbakhsh, AR, Ebrahim-Saraie, HS, Sadeghi, RV & Rajabi, A 2016, 'Associations Between Socio-Environmental Determinants and the Risk of Pulmonary Tuberculosis in Guilan, Iran', Archives of Clinical Infectious Diseases, vol. 11, no. 1.

Tesema, C, Tadesse, T, Gebrehiwot, M, Tsegaw, A & Weldegebreal, F 2015, 'Environmental and host-related determinants of tuberculosis in Metema district, north-west Ethiopia', Drug, healthcare and patient safety, vol. 7, p. 87.

Tipayamongkholgul, M, Podang, J & Siri, S 2013, 'Spatial analysis of social determinants for tuberculosis in Thailand', Journal of the Medical Association of Thailand= Chotmaihet thangphaet, vol. 96, pp. S116-21.

WHO 2010, 'Action on the social determinants of health: Learning from previous experiences'.

—— 2012, 'Global tuberculosis report 2012', World Health Organization, Geneva http://apps. who. int/iris/bitstream/10665/91355/1/9789241564656_eng. pdf.

Wong, MK, Yadav, RP, Nishikiori, N & Eang, MT 2013, 'The association between household poverty rates and tuberculosis case notification rates in Cambodia, 2010', Western Pacific surveillance and response journal : WPSAR, vol. 4, no. 1, pp. 25-33.

Yang, Z, Kong, Y, Wilson, F, Foxman, B, Fowler, AH, Marrs, CF, Cave, MD & Bates, JH 2004, 'Identification of risk factors for extrapulmonary tuberculosis', Clinical infectious diseases, vol. 38, no. 2, pp. 199-205.