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A picture is worth a thousand words: Combining the location of TB with social determinants of health to inform interventions to reduce TB among children in Worcester, South Africa

Combining the location of TB with social determinants of health to inform interventions to reduce TB among children in Worcester, South Africa
Publication date: 
Oct 2019

Background to Worcester, Breede Valley

  • Worcester is a town in the Breede Valley sub district of Cape Winelands in the Western Cape Province of South Africa with a population of 97,078. 
  • In 2018 in Breede Valley 1,927 people were diagnosed with TB of which 22% were children aged below 5 years old.  
  • 1,047 of these TB patients were living in Worcester of which 206 were children - 20% of the burden

Geo-mapping TB in Worcester

  • ConnecTB, a mobile health application was used to pinpoint the homes of 231 TB patients in Worcester. 
  • The results showed that most lived in 3 areas of which the highest number of TB patients resided in an area furthest from any health facility: 

Geo-mapping social determinants of health in Worcester  

National census data on dwelling density, education and income was then overlaid and it showed a correlation to the high TB burden areas

  • Reasons for each determinant:  
    • High dwelling density
      • Low-cost housing with back rooms for rent to migrants
      • Failure of government subsidy housing due to gangsterism
    • Lack of any schooling
      • Pregnancy among youth without family support
      • Gangsterism (in and out of school)
      • Drug abuse (especially “tik” – Methamphetamine)
      • Poor parental support and peer pressure
    • Lack of income
      • Mainly due to lack of schooling
      • Only available employment is seasonal
      • Dependency on social grants 
      • Misuse of grant income especially for alcohol
      • High number of family members dependant on low income 

Outcomes of geo-mapping

Informed, targeted interventions to address the TB burden:  

  • 2017: Contact tracing by Community Healthcare Workers in Avian Park to locate and screen the 650 contacts of the 101 TB patients geo-mapped
  • 2018: Establishment of the Avian Park COPC (Community-Orientated Primary Care) facility to provide services to TB patients in the Avian Park community – 87% of 39 children supported completed their treatment successfully in 2019   
  • 2019: Implementation of Buddy Beat TB (blue cat-like friend) at pediatric ward in the Brewelskloof TB hospital to support children with drug-resistant TB from areas including  Avian Park

Conclusion 

  • Creating geo-location maps to show TB hotspots is only the first step in understanding the reasons behind the burden in a specific area. 
  • Additional data such as social determinants of health must also be mapped and analysed to inform interventions for impact.