Abstract:
Background: The role played by social determinants of health including social, economic, environmental and
cultural factors in influencing health outcomes for many health conditions has been widely described. However, the
potential impact of these factors on morbidity and mortality of infectious diseases particularly tuberculosis (Tb)/HIV
co-infection mortality is scantly addressed. We assessed the role that social determinants play in Tb/HIV co-infection
mortality in southwest Ethiopia.
Methods: A retrospective cohort study collated Tb and HIV data from Jimma University Teaching Hospital, Southwest
Ethiopia for the period of September 2010 and August 2012. Data analysis was conducted using STATA version 14 for
mackintosh. Both descriptive and inferential statistics analyses were performed. Logistic regression was applied to
identify factors associated with Tb/HIV co-infection mortality at P value of ≤0.05 in the final model.
Results: Fifty-five (20.2 %) patients died during the study period. Compared to their counterparts, more Tb/HIV
co-infection death was observed in young age groups between 25 and 34 years (47.3 %), females (58.2 %), daily
labors (40 %) and Muslim followers (54.5 %). 43.6 and 41.8 % of study participants respectively had single and double
bedrooms, and 25.5 and 23.6 % of deceased study participants did not have water and electricity in the household
respectively. Logistic regression analyses demonstrated the following factors significantly associated with Tb/HIV coinfection mortality: being a commercial sex worker (AOR, 5.6; 95 % CI, 1.2–25.8), being of bed ridden functional status
(AOR, 3.9; 95 % CI, 1.5–10.3) and being a rural resident (AOR, 3.4; 95 % CI, 1.4–8.4).
Conclusions: One-fifth of Tb/HIV co-infected patients died due to the co-infection. Social determinants including
type of occupation, severity of disease and residing in rural areas seemed to have a significant association with the
poor disease outcome. Findings of this study inform the role that social determinants play in influencing mortality
due to Tb/HIV co-infection. Consistent with principles of primary health care as stated by Alma Ata declaration, and
in order to achieve better disease outcomes, intervention frameworks that address Tb/HIV mortality should not only
focus on the medical interventions of diseases, but should also integrate and improve social determinants of affected
populations.
