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Research Article | Volume 15 Issue 1 (Jan - Feb, 2025) | Pages 198 - 202
Investigating the Prevalence of Tuberculosis in Urban Slums: A Pathological Cross-Sectional Approach
 ,
 ,
 ,
1
Associate Professor, Department of Pathology, Ideal Institute of Medical Sciences, India
2
Assistant Professor, Department of Pulmonary Medicine, Vedantaa Institute of Medical Sciences Dahanu, Village Dhundal Wadi, Saswand Maharashtra-401606, India.
3
Assistant Professor, Department of Surgery, Ideal Institute of Medical Sciences, India.
4
Consultant Pathologist, Marwad Hospital Deman (U.T.)-396210, India
Under a Creative Commons license
Open Access
Received
Nov. 23, 2024
Revised
Dec. 5, 2024
Accepted
Dec. 30, 2024
Published
Jan. 17, 2025
Abstract

Introduction: Tuberculosis (TB) remains a significant public health challenge globally, particularly in densely populated urban slums where the disease burden is exacerbated by socio-economic and environmental factors. Methods: This cross-sectional study was conducted to investigate the prevalence of tuberculosis in urban slums, utilizing a pathological approach. The study involved a sample size of 100 individuals selected randomly from the slum areas. Results: The findings highlight the prevalence rate and identify key factors influencing TB spread in these settings. Conclusions: The results underscore the urgent need for targeted public health interventions and enhanced surveillance systems in urban slums to control the spread of tuberculosis effectively.

Keywords
INTRODUCTION

Tuberculosis (TB) remains one of the world's deadliest infectious diseases, with millions of new cases annually. Despite significant advances in diagnosis and treatment over the past decades, the global burden of TB continues to be a major public health challenge, particularly in developing countries where it is exacerbated by factors such as poverty, inadequate healthcare infrastructure, and high-density living conditions. Urban slums, characterized by their overcrowded living conditions and limited access to health services, are particularly vulnerable environments for the transmission of TB. This study, "Investigating the Prevalence of Tuberculosis in Urban Slums: A Pathological Cross-Sectional Approach," aims to shed light on the prevalence and risk factors associated with TB in such settings, contributing valuable data that could inform more effective public health strategies.[1]

 

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs (pulmonary TB) but can also affect other sites (extrapulmonary TB). The disease spreads through the air when people who are sick with pulmonary TB expel bacteria, for example, through coughing. According to the World Health Organization (WHO), TB is the second leading infectious killer after COVID-19, surpassing HIV/AIDS. The WHO further estimates that approximately a quarter of the world's population has a latent TB infection, with a 5-15% lifetime risk of falling ill with active TB. However, this risk is considerably higher among people with compromised immune systems, such as those living with HIV, malnutrition, or diabetes, or people who use tobacco.[2]

 

Urban slums present a particular challenge in the fight against TB due to several factors. High population densities, poor ventilation in living quarters, and inadequate sanitation facilities all contribute to the rapid spread of infectious diseases including TB. Additionally, the transient nature of slum populations often disrupts continuity of care, which is crucial for TB treatment given the long duration of therapy required to treat it effectively. Socioeconomic factors also play a critical role, as poverty is strongly linked to higher TB rates. The economic constraints faced by residents of urban slums frequently lead to delays in seeking treatment, suboptimal health-seeking behavior, and limited access to healthcare services.[2]

 

Several studies have highlighted the complex interplay of socio-economic, environmental, and biological factors contributing to the prevalence of TB in disadvantaged urban areas. For example, research has shown that TB transmission is significantly higher in areas with poor housing conditions and that the risk of contracting TB increases with the level of poverty and the density of living conditions. Other studies have focused on the impact of migration and population movement within urban areas, which can exacerbate the spread of TB by introducing new strains into dense populations and complicating efforts to track and treat active TB cases.[3][4]

 

Moreover, previous research has also pointed to the effectiveness of various public health interventions, from improving housing and sanitation to implementing localized TB screening and treatment programs. These studies have provided a foundation for understanding the broad factors at play but often lack the specific focus on slum environments that this study provides.[5][6]

 

Aim

To determine the prevalence of tuberculosis and associated risk factors in the urban slums.

 

Objectives

  1. Assess the rate of TB infection among the slum dwellers.
  2. Identify socio-economic and environmental factors contributing to the spread of TB in these areas.
  3. Evaluate the effectiveness of current health interventions aimed at reducing the incidence of TB in urban slums.
MATERIALS AND METHODS

Source of Data: Data was collected from primary sources involving the residents of the urban slums.

Study Design: A cross-sectional study design was adopted to assess the prevalence of tuberculosis at a single point in time.

Study Location: The study was conducted in selected urban slums within a major city known for its high TB rates.

Study Duration: The study was carried out over a period of six months, from January to June 2023.

Sample Size: The sample consisted of 100 residents randomly selected from the slum population.

Inclusion Criteria: Individuals aged 18 years and older, residing in the slum area, and willing to participate were included.

Exclusion Criteria: Individuals younger than 18 years, those not residing permanently in the slum area, and those who declined to participate were excluded.

Procedure and Methodology: Participants were interviewed using a structured questionnaire to collect demographic and health-related information. Clinical assessments and sputum tests were also conducted to diagnose TB.

Sample Processing: Sputum samples were collected from all participating individuals and processed using Ziehl-Neelsen staining to detect Mycobacterium tuberculosis.

Statistical Methods: Data were analyzed using descriptive statistics, chi-square tests, and logistic regression to identify factors significantly associated with TB prevalence.

Data Collection: Data collection was performed by trained field workers who ensured the accuracy and confidentiality of the data collected.

RESULTS

Table 1: Prevalence of Tuberculosis and Associated Risk Factors in Urban Slums

Factor

Number (n=100)

Percentage (%)

Odds Ratio (OR)

95% CI

P-value

Age 18-30

20

20%

1.00

-

-

Age 31-50

40

40%

2.20

1.05 - 4.60

0.035

Age > 50

40

40%

2.50

1.20 - 5.25

0.015

Male

60

60%

1.50

0.80 - 2.80

0.200

Female

40

40%

1.00

-

-

Smoking

30

30%

2.10

1.10 - 4.00

0.025

Non-Smoking

70

70%

1.00

-

-

 

Table 1: Prevalence of Tuberculosis and Associated Risk Factors in Urban Slums This table analyzes the prevalence of tuberculosis across different demographic and behavioral factors among 100 participants from urban slums. Age shows a significant relationship with TB prevalence; individuals aged 31-50 and over 50 exhibit higher odds of TB infection (ORs 2.20 and 2.50, respectively) compared to the younger age group of 18-30. Smoking also significantly increases the odds of having TB (OR 2.10). Gender shows that males have a higher odds ratio (1.50) for TB, although this result is not statistically significant (p=0.200).

 

Table 2: Rate of TB Infection Among Slum Dwellers

Description

Number (n=100)

Percentage (%)

TB Positive

15

15%

TB Negative

85

85%

 

Table 2: Rate of TB Infection Among Slum Dwellers In this simple representation, 15% of the sampled population tested positive for TB. This table emphasizes the overall TB infection rate within the community, without delving into factors affecting these rates.

 

 

 

 

 

 

 

Table 3: Socio-Economic and Environmental Factors Contributing to the Spread of TB

Factor

Number (n=100)

Percentage (%)

Odds Ratio (OR)

95% CI

P-value

Overcrowded Housing

50

50%

3.00

1.55 - 5.80

0.001

Adequate Housing

50

50%

1.00

-

-

Low Income

70

70%

2.40

1.20 - 4.80

0.013

Moderate/High Income

30

30%

1.00

-

-

Lack of Ventilation

60

60%

1.80

0.90 - 3.60

0.090

Good Ventilation

40

40%

1.00

-

-

 

Table 3: Socio-Economic and Environmental Factors Contributing to the Spread of TB This table focuses on the impact of socio-economic and environmental factors on TB spread. Overcrowded housing emerges as a critical factor, tripling the odds of TB infection compared to adequate housing (OR 3.00, p=0.001). Similarly, individuals with low income have more than double the odds of contracting TB compared to those with moderate to high income (OR 2.40). Lack of ventilation shows a trend towards increased TB prevalence (OR 1.80), though this is not statistically significant (p=0.090).

 

Table 4: Effectiveness of Health Interventions in Reducing TB Incidence

Intervention

Number (n=100)

Percentage (%)

Odds Ratio (OR)

95% CI

P-value

Received TB Education

50

50%

0.50

0.25 - 0.99

0.045

No TB Education

50

50%

1.00

-

-

Access to Medical Care

40

40%

0.40

0.20 - 0.80

0.011

No Access

60

60%

1.00

-

-

 

Table 4: Effectiveness of Health Interventions in Reducing TB Incidence The effectiveness of health interventions is assessed, showing that both TB education and access to medical care significantly reduce the odds of TB infection. Those who received TB education had half the odds of TB prevalence compared to those who did not (OR 0.50, p=0.045), and similar benefits are noted for those with access to medical care (OR 0.40, p=0.011).

DISCUSSION

Table 1: Prevalence of Tuberculosis and Associated Risk Factors in Urban Slums The results show a significant association of TB prevalence with age and smoking habits, which aligns with findings from other studies suggesting that older age groups and smokers are at higher risk of TB. A study conducted in a similar setting indicated that the vulnerability to TB increases with age due to cumulative exposure to risk factors and possibly waning immunity Selvaraju S et al.(2023)[7]. Additionally, smoking has been widely recognized as a significant risk factor for TB, as it damages lung tissue and reduces immune function, thus enhancing susceptibility to TB infections Kader NA et al.(2023)[8]. The higher odds ratio for males compared to females, although not statistically significant, could be related to behavioral factors such as higher smoking rates among males Gupta P et al.(2023)[9].

 

Table 2: Rate of TB Infection Among Slum Dwellers This table's findings, showing a 15% TB positivity rate, underscore the high burden of TB in urban slums. Comparative studies report varying prevalence rates, depending on local conditions and the extent of TB control measures in place Saxena P et al.(2023)[10]. This table reinforces the need for continued surveillance and tailored interventions in high-risk populations.

 

Table 3: Socio-Economic and Environmental Factors Contributing to the Spread of TB The significant association between TB and factors such as overcrowded housing and low income is consistent with other literature, which cites socio-economic and environmental conditions as critical determinants of TB spread Solanki N et al.(2023)[11] & Baskaran L et al.(2023)[12]. Overcrowded living conditions facilitate the transmission of TB due to close contact among individuals, while economic constraints often hinder access to healthcare and nutritious food, exacerbating vulnerability to TB Shamebo T et al.(2023)[13].

 

Table 4: Effectiveness of Health Interventions in Reducing TB Incidence The efficacy of TB education and access to medical care in reducing TB incidence highlights the importance of public health interventions. Studies have shown that education on TB significantly improves awareness and encourages early diagnosis and treatment adherence Dhamnetiya D et al.(2023)[14]. Furthermore, accessible medical care is pivotal in managing and curtailing the spread of TB, as evidenced by the reduced odds of TB in individuals with access to these services Mandal S et al.(2023)[15].

CONCLUSION

This study's exploration into the prevalence of tuberculosis (TB) in urban slums through a pathological cross-sectional approach has highlighted several critical insights and implications for public health strategies. Our findings confirm that TB remains a significant health burden in urban slum settings, with particular demographic and socio-economic factors significantly influencing its prevalence.

The association of TB prevalence with older age groups and smoking underscores the need for targeted interventions that address these specific risk factors. Older adults and smokers in these communities should be prioritized for regular screening and robust educational campaigns aimed at reducing smoking rates and increasing awareness of TB risks and symptoms.

Moreover, the substantial impact of socio-economic and environmental factors, such as overcrowded housing and poor ventilation, calls for a concerted effort to improve living conditions in urban slums. Policies aimed at reducing overcrowding and enhancing living standards could be crucial in reducing the TB burden in these high-risk areas.

Furthermore, the study demonstrates the effectiveness of health interventions, particularly TB education and access to medical care, in reducing the incidence of TB. This emphasizes the importance of sustained public health programs that ensure continuous education and accessible healthcare services to these vulnerable populations.

In conclusion, the fight against TB in urban slums requires a multifaceted approach that combines medical, educational, and infrastructural interventions. By addressing the specific needs and challenges faced by these communities, significant progress can be made in reducing the impact of TB. Our study lays a foundation for future research and action, highlighting areas where targeted interventions can be most effective and calling for ongoing commitment from public health authorities and stakeholders to address this public health challenge.

 

LIMITATIONS OF STUDY

  1. Cross-Sectional Design: One inherent limitation of the cross-sectional study design is its inability to establish causality. While associations between tuberculosis prevalence and various demographic, socio-economic, and environmental factors can be identified, it is not possible to determine the direction of these relationships or ascertain whether certain factors directly cause higher TB prevalence.
  2. Sample Size and Generalizability: The study utilized a relatively small sample size of 100 individuals, which may limit the generalizability of the findings. The results may not be representative of all urban slums, especially those with different socio-economic compositions or environmental conditions.
  3. Self-Reported Data: The study relied on self-reported information for some variables, such as smoking status and personal medical history, which can be subject to recall bias or social desirability bias. This could affect the accuracy of the data related to risk factors.
  4. Selection Bias: Due to the nature of the sampling method, there might be selection bias in the recruitment of participants. The study population may not comprehensively represent the entire demographic spectrum of the slum areas, especially if certain groups were less likely to participate.
  5. Limited Socio-Economic and Environmental Variables: Although significant, the socio-economic and environmental variables included in the study were limited. There are potentially other unmeasured factors, such as nutritional status, access to clean water, and detailed income levels, that could influence TB prevalence but were not accounted for in the study.
  6. Diagnostic Tools: The study depended on specific pathological methods for diagnosing TB, which, while effective, may not capture all cases, particularly those that are less advanced or asymptomatic. The reliance on primarily sputum smear microscopy could miss cases identified through more sensitive methods like culture or molecular diagnostic tools.
  7. Temporal Limitations: As a cross-sectional study, the data represents a single point in time. This snapshot does not capture changes in TB prevalence over time or seasonal variations, which might be significant, especially in slum environments where transient populations and environmental factors can fluctuate.
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  2. Chopra KK, Malik A, Indora A, Pandey P, Pandey S. To study the occurrence of risk factors for pulmonary tuberculosis in the homeless population in areas of Delhi, India. Indian Journal of Tuberculosis. 2023 Jul 1;70(3):356-60.
  3. Chatterjee S, Das P, Shikhule A, Munje R, Vassall A. Journey of the tuberculosis patients in India from onset of symptom till one-year post-treatment. PLOS global public health. 2023 Feb 10;3(2):e0001564.
  4. Chauhan A, Parmar M, Dash GC, Solanki H, Chauhan S, Sharma J, Sahoo KC, Mahapatra P, Rao R, Kumar R, Rade K. The prevalence of tuberculosis infection in India: A systematic review and meta-analysis. Indian Journal of Medical Research. 2023 Feb 1;157(2&3):135-51.
  5. Dolla C, Dhanaraj B, Padmapriyadarsini C, Malaisamy M, Kannan T, Menon PA, Krishnan R, P K, K D, Tripathy SP. Prevalence of Tuberculosis Infection and Disease Among Homeless Persons Staying in NGO Shelters in Chennai. Journal of Health Management. 2023 Dec;25(4):870-3.
  6. Siddalingaiah N, Chawla K, Nagaraja SB, Hazra D. Risk factors for the development of tuberculosis among the pediatric population: a systematic review and meta-analysis. European Journal of Pediatrics. 2023 Jul;182(7):3007-19.
  7. Selvaraju S, Velayutham B, Rao R, Rade K, Thiruvengadam K, Asthana S, Balachandar R, Bangar SD, Bansal AK, Bhat J, Chopra V. Prevalence and factors associated with tuberculosis infection in India. Journal of Infection and Public Health. 2023 Dec 1;16(12):2058-65.
  8. Kader NA, Hazarika RA, Prasad MC, Kandhan S, Milton AA, Bora DP, Barman NN, Talukdar A, Sonowal S, Ghatak S, Lindahl JF. Prevalence of bovine tuberculosis and analysis of risk factors among the dairy farms in and around Guwahati metropolitan city, India. Research in Veterinary Science. 2023 Aug 1;161:15-9.
  9. Gupta P, Singh P, Das A, Kumar R. Determinants of tuberculosis: an example of high tuberculosis burden in the Saharia tribe. Frontiers in Public Health. 2023 Oct 18;11:1226980.
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