Multimorbidity and health-related quality of life after tuberculosis treatment in Zimbabwe: A cross-sectional study with household comparators
10 affiliations
- 1National Heart and Lung Institute, Imperial College London, London, United Kingdom
- 2Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- 3The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- 4National Tuberculosis & AIDS Programme, Ministry of Health and Child Care, Harare, Zimbabwe
- 5Global Health and Ageing Research Unit, University of Bristol, Bristol, United Kingdom
- 6Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- 7Biomedical Research and Training Institute, Harare, Zimbabwe
- 8TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- 9Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- 10German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
Abstract
Chronic conditions both drive development of and are consequences of tuberculosis (TB). While there is growing awareness of chronic lung disease, data on other health conditions post-TB are limited. In this cross-sectional study in Zimbabwe, we offered adults with pulmonary TB an integrated health check at or after treatment completion, assessing uptake and yield. Members of the same households were also offered the intervention. Selecting household members without prior or current TB as a comparator, we calculated odds ratios (OR) for HIV, diabetes, hypertension, underweight, anaemia, symptoms of mental health disorders, self-reported memory difficulty, vision impairment, chronic lung disease and multimorbidity (two or more of the above); and compared health-related quality of life (HRQoL; EQ-5D value). Of 229 people with TB invited, 96 (42%) participated (median age 38 years, 54% men, median 356 days from diagnosis). Common reasons for non-participation were migration and work. Among people with TB, chronic conditions were common and, other than HIV, mostly undiagnosed. Ninety-one percent of people with recent TB had at least one chronic condition; almost two-thirds had two or more. Compared to 285 household comparators (median age 34 years, 71% female) and after adjustment for age and sex, people with recent TB were more likely to have at least one chronic condition (OR 2.30 [95% confidence interval 1.03–5.11]) but not multimorbidity (1.55 [0.86–2.78]). People with recent TB had greater odds of HIV (1.77 [1.03–3.04]), symptoms of mental health disorders (1.57 [0.96–2.56]), self-reported memory difficulty (2.13 [1.19–3.80]), impaired lung function (3.24 [1.46–7.20] among 39/92 people with TB and 155/285 household comparators with data available), and underweight (5.15 [2.28–11.61]) compared to household comparators without prior TB; hypertension was less common (0.40 [0.20–0.79]) and HRQoL was worse (p = 0.005). Uptake of chronic disease screening among people with recent TB was low, but prevalence of chronic conditions was high. Holistic approaches to treatment which identify and address these conditions are needed. The contribution of post-TB multimorbidity to morbidity and mortality among TB survivors should be included in global disease estimates. Whilst comparison to household controls aimed to reduce confounding by socio-economic status, a limitation of this approach is externality, whereby the health status of the person with TB influenced that of their household members.
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BibTeX
@article{calderwood2026multimorbidity,
title = {{Multimorbidity and health-related quality of life after tuberculosis treatment in Zimbabwe: A cross-sectional study with household comparators}},
author = {Claire Jacqueline Calderwood and Edson T. Marambire and Trevor Musunzuru and Karlos Madziva and Fungai Kavenga and Eveline Muringi and Justin Dixon and Junior Mutsvangwa and Celia L. Gregson and Rashida Abbas Ferrand and Katherine Fielding and Katharina Kranzer},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0007119},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007119},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Multimorbidity and health-related quality of life after tuberculosis treatment in Zimbabwe: A cross-sectional study with household comparators
AU - Claire Jacqueline Calderwood
AU - Edson T. Marambire
AU - Trevor Musunzuru
AU - Karlos Madziva
AU - Fungai Kavenga
AU - Eveline Muringi
AU - Justin Dixon
AU - Junior Mutsvangwa
AU - Celia L. Gregson
AU - Rashida Abbas Ferrand
AU - Katherine Fielding
AU - Katharina Kranzer
PY - 2026
DA - 2026/09/01
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007119
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007119
AB - Chronic conditions both drive development of and are consequences of tuberculosis (TB). While there is growing awareness of chronic lung disease, data on other health conditions post-TB are limited. In this cross-sectional study in Zimbabwe, we offered adults with pulmonary TB an integrated health check at or after treatment completion, assessing uptake and yield. Members of the same households were also offered the intervention. Selecting household members without prior or current TB as a comparator, we calculated odds ratios (OR) for HIV, diabetes, hypertension, underweight, anaemia, symptoms of mental health disorders, self-reported memory difficulty, vision impairment, chronic lung disease and multimorbidity (two or more of the above); and compared health-related quality of life (HRQoL; EQ-5D value). Of 229 people with TB invited, 96 (42%) participated (median age 38 years, 54% men, median 356 days from diagnosis). Common reasons for non-participation were migration and work. Among people with TB, chronic conditions were common and, other than HIV, mostly undiagnosed. Ninety-one percent of people with recent TB had at least one chronic condition; almost two-thirds had two or more. Compared to 285 household comparators (median age 34 years, 71% female) and after adjustment for age and sex, people with recent TB were more likely to have at least one chronic condition (OR 2.30 [95% confidence interval 1.03–5.11]) but not multimorbidity (1.55 [0.86–2.78]). People with recent TB had greater odds of HIV (1.77 [1.03–3.04]), symptoms of mental health disorders (1.57 [0.96–2.56]), self-reported memory difficulty (2.13 [1.19–3.80]), impaired lung function (3.24 [1.46–7.20] among 39/92 people with TB and 155/285 household comparators with data available), and underweight (5.15 [2.28–11.61]) compared to household comparators without prior TB; hypertension was less common (0.40 [0.20–0.79]) and HRQoL was worse (p = 0.005). Uptake of chronic disease screening among people with recent TB was low, but prevalence of chronic conditions was high. Holistic approaches to treatment which identify and address these conditions are needed. The contribution of post-TB multimorbidity to morbidity and mortality among TB survivors should be included in global disease estimates. Whilst comparison to household controls aimed to reduce confounding by socio-economic status, a limitation of this approach is externality, whereby the health status of the person with TB influenced that of their household members.
SN - 2767-3375
ER -