The association of household conditions with the development of active pulmonary TB among in households with a previous TB patient: a community-based case-control study.

BACKGROUND

Poor housing has been linked to tuberculosis (TB), yet details of living conditions are less well studied.

METHODS

This community-based case-control study examined household and individual factors associated with active pulmonary TB among households with a prior TB patient in Padang City, West Sumatra, Indonesia. Confirmed TB cases (CS, 105), symptomatic confirmed non-TB controls (CN1, 104), and asymptomatic controls (CN2, 102) were recruited at primary health centres from August to December 2024. Inclusion criteria were informed consent and ability to communicate; controls with a history of active TB were excluded from analysis. Participants were interviewed regarding individual characteristics, and a home visit made to record household conditions (temperature, humidity, carbon dioxide content and wind speed of living room air, house dimensions and construction materials). Multivariable multinomial logistic regression identified associations (relative probability ratios) of individual and household variables between cases and each control group.

RESULTS

Case status was associated with small bedroom volume (< 12m3), compared with CN2 (3.74 [1.25, 11.20]), and with gypsum/plaster ceilings compared with CN1 (11.24 [2.52, 50.10]. In both comparisons, case status was associated with outdoor occupation (10.13, [1.69, 60.61] and 18.60, [2.53, 137.0]), frequent coffee shop visits (10.17 [1.32, 78.55] and 24.06 [2.22, 261.0]), and time elapsed of > 1 year since the prior TB patient (21.64 [8.73, 53.64] and 13.91 [5.82, 33.24]). Compared with CN1, case status was associated with the prior patient being a sibling (8.72 [2.33, 32.57]), grandparent/parent (5.31 [1.51, 18.70]) or other relative (4.23 [1.16, 15.45]) rather than spouse. The relative probability of outdoor activity was lower among cases (0.25, [0.10, 0.62] compared with CN2), and that of being underweight higher (4.71 [1.77, 12.53] and 6.35 [2.35, 17.18]), possibly consequences of ill-health.

CONCLUSION

Among this population, small bedroom volume, gypsum/plaster ceiling, frequent coffee shop visits, outdoor occupation, non-spousal relationship with the prior TB patient and elapsed time of > 1 year increased the relative probability of being a TB patient. These findings suggest interventions such as improving bedroom space and targeted screening in households with prior TB, especially after one year. Housing improvements, though long-term, may usefully complement behavioural interventions for sustainable TB control.