Research discovers that TB is more likely to kill more South African men than women
Researchers have discovered in new research a worrying concern about higher rates of TB among men in South Africa.
University professors Mmamapudi Kubjane, and Leigh Johnson, at the University of Witwatersrand and Cape Town universities, in their research titled: Drivers of sex differences in the South African adult tuberculosis incidence and mortality trends 1990–2019 discovered that various factors contribute to this.
South Africa is one of the leading six nations that account for 60% of the worldwide tuberculosis burden.
Per the findings, 70% of men are more prone to developing TB which can result in death, compared to women. The study found that in 2019, 801 per 100,000 adult men developed TB while the rate was 478 per 100,000 among women.
The researchers employed the Thembisa TB model, developed at the Center for Infectious Disease Epidemiology and Research. The model is designed to examine the South African adult TB epidemic over time. Considering that HIV is the most significant risk factor for TB and the primary driver of the epidemic, the TB model was integrated with the existing Thembisa HIV model, revealing a startling statistic: around 60% of individuals with active TB also live with HIV.
The model further demonstrated that, between 1990 and 2019, South African men suffered from TB and faced higher mortality rates than women. Astonishingly, in 2019, there were 1.6 times more new TB cases and 1.7 times more TB-related deaths in men compared to women, even though HIV was more prevalent among women.
The study further discovered that several factors contributed to this gender disparity in TB incidence and mortality.
Excessive alcohol consumption, smoking, diabetes, and undernutrition were all identified as key factors. In 2019, of the 801 per 100,000 adult men who developed TB, 51% of cases were attributed to heavy alcohol use, 30% to smoking, and 16% to undernutrition.
In contrast, the numbers for women were significantly lower, with 30% of the 478 per 100,000 adult women who developed TB being attributed to heavy alcohol use, 15% to smoking, and 11% to undernutrition.
The research also highlighted lower testing rates and delays in initiating TB treatment among men, contributing to a 7% higher mortality rate. Factors such as job commitments and the financial impact of taking time off for clinic visits often deterred men from seeking healthcare. Moreover, men tended to be older and sicker when they eventually sought treatment, making it more challenging for them to recover.
One notable finding was the positive impact of HIV healthcare services on women, particularly in terms of HIV testing and antiretroviral therapy initiation. These services significantly reduced TB incidence and mortality in women.
In 2019, primarily due to HIV treatment, TB cases among women decreased by 38%, with a 52% reduction in deaths. In contrast, TB cases among men only dropped by 18%, resulting in a 29% reduction in deaths.
The high incidence and mortality rates of TB among men underscore the need to make healthcare services more accessible and to address structural barriers that hinder their retention in TB and HIV care. Proposed solutions include the introduction of mobile clinics at workplaces to provide testing for TB, HIV, and other potential co-morbidities.
Socioeconomic interventions are also important. Successful anti-smoking programs driven by health practitioners and family members have shown success rates of up to 82% worldwide.
Combating excessive alcohol consumption should encompass self-help programs alongside structural interventions like increased alcohol taxation and stricter enforcement of alcohol sale restrictions.
