"TB is the child of poverty - and also its parent and provider"

This quote from Archbishop Desmond Tutu encapsulates the link between TB and poverty.

TB is much more common in poor communities because

• Overcrowding is common - people are likely to live in dark, unventilated rooms, and thus more likely to be infected by TB and to receive large doses of the bacilli.
• Patients’ resistance to the disease is reduced, particularly by malnutrition and other diseases such as HIV.

TB makes patient and family poorer because

• The patient will probably be unable to work
• Patients in remote areas may not be aware of or able to access free treatment and may end up paying more than they can afford to traditional healers or doctors who are not experts in TB.
• Where treatment and drugs are free there is often a cost of travelling to clinics, both to collect drugs or to have each dose supervised.
• Studies suggest on average patients lose 3-4 months of work time.  The annual loss is equivalent to loss of 20-30% of the family household income.  If a patient dies the family loses about 15 years of income.
• The presence of a TB patient in a household entails major reallocation of time and resources towards care of the patient, and away from work. 
• If wife develops TB it is not uncommon for the husband to leave her.  For female members of the family the stigma attaching to TB may prevent marriage.

Coping strategies

• The family may sell assets because of reduced income – pushing them further into poverty and losing their future potential for earning.
• The family may end up begging.
• Patients and their families may stop using water from the public tap because it costs too much – and go back to using open water sources