Social determinants of tuberculosis in Addis Ababa, Ethiopia: a qualitative study

Tuberculosis (TB) is a complex health problem that requires an integrated approach that considers economic, environmental, and social factors to reduce the global burden of TB. To develop a comprehensive strategy for TB eradication, addressing the social determinants of TB is crucial. This study aimed to explore the experiences of healthcare workers and patients regarding the social determinants of health in the context of TB in Addis Ababa, Ethiopia. Purposive sampling was employed to select 20 healthcare workers and 24 individuals with TB. Key informant interviews were conducted with healthcare workers managing TB patients and individuals with TB who presented at selected health centers. A semi-structured interview guide was used to collect the data. The guide included questions to capture participants' experiences of economic barriers, TB-related stigma, family and community support, food access, and housing conditions. Data were analyzed thematically and direct quotes were included. Forty-four participants were included, including 20 healthcare workers (16 men and four women) and twenty-four TB patients (nine men and 15 women). Key themes emerged, including economic barriers, with participants stating that financial constraints delayed TB care-seeking; stigma associated with TB, leading to fear of disclosure and social isolation; social support, with family and community networks playing a central role in facilitating care; food insecurity, with participants reporting the profound impact of food insecurity on TB vulnerability; exposure to smoke, with participants citing exposure to cigarette smoke as a potential risk factor for developing TB; and housing conditions, with participants stating that overcrowded living environments facilitate TB transmission. Economic barriers, TB-related stigma, a lack of social support, food insecurity, and exposure to cigarette smoke are key social determinants of TB. These findings underscore the need to address social determinants of TB through targeted interventions, such as stigma reduction campaigns, financial assistance, and community support programs, to reduce the TB burden in Addis Ababa.