Background: Studies on social determinants of TB using big microdata in sub-Saharan Africa (SSA) are scarce. The study identified the social determinants of TB and TB-related outcomes in Lesotho. Methods: We conducted a secondary analysis of data from the 2023 Lesotho Demographic and Health Survey (DHS). The outcome variables were 'had TB,' 'TB-related stigma,' 'depression and anxiety,' 'cigarette smoking,' and ‘health insurance ownership’ among TB patients. The explanatory variables were individual, household, and health characteristics. We used Pearson's chi-squared test and complex sample logistic regression to identify the predictors of the outcome variables at a p-value of less than 0.05. Results: TB prevalence significantly decreased with increasing age: 15-19 years (AOR=0.12, 95%CI:0.06-0.28, p<0.001), 20-29 years (AOR=0.16, 95%CI:0.08-0.31, p<0.001), and 30-39 years (AOR=0.40, 95%CI:0.24-0.64, p<0.001). Nevertheless, secondary education (AOR=2.85, 95%CI:1.04-7.83, p=0.042), clerical/sales/service occupation (AOR=2.55, 95%CI:1.18-5.49, p=0.017), HIV (AOR=3.20, 95%CI:1.30-7.85, p=0.011), and no stigma (AOR=3.45, 95%CI:1.83-6.50, p<0.001) increased the likelihood of having TB. Not having TB (AOR=2.41, 95%CI:1.42-4.11, p=0.001), being male (AOR=2.02, 95%CI:1.47-2.77, p<0.001), 15-19 years (AOR=4.40, 95%CI:2.51-7.70, p<0.001), 20-29 years (AOR=2.21, 95%CI:1.41-3.47, p=0.001), primary education (AOR=3.53, 95%CI:1.83-6.79, p<0.001), secondary education (AOR=2.73, 95%CI:1.49-5.01, p=0.001), and not working (AOR=1.52, 95%CI:1.02-2.27, p=0.039) increased the likelihood of TB-related stigma. Being male (AOR=35.80, 95%CI:11.82-108.44, p<0.001), no media exposure (AOR=9.22, 95%CI:2.88-29.45, p<0.001), low media exposure (AOR=4.06, 95%CI:1.37-11.98, p=0.012) and alcohol use (AOR=7.03, 95%CI:2.31-21.40, p=0.001) increased the odds of smoking among TB patients. Residing in urban areas (AOR=10.23, 95%CI:1.38-77.15, p=0.024), large households (AOR=11.15, 95%CI:2.27-54.68, p=0.003), and lack of a mobile phone (AOR=4.45, 95%CI:1.97-10.04, p<0.001) increased the odds of depression among TB patients. Being male (AOR=18.36, 95%CI:4.21-80.16, p<0.001), poorer (AOR=1.18, 95%CI:0.15-9.24, p<0.001), middle (AOR=3.05, 95%CI:0.47-19.57, p=0.002), richer (AOR=4.82, 95%CI:0.77-30.01, p=0.011), and richest (AOR=22.57, 95%CI:4.13-123.30, p<0.001) increased the odds of health insurance coverage among TB patients. Conclusions: Evidence from Lesotho DHS highlights how microdata can enhance our understanding of the social determinants of TB in SSA. To effectively reduce vulnerability to TB and disparities in access to TB care, it is essential to integrate this evidence into Lesotho’s TB control program and its multisectoral accountability framework for TB. We recommend that SSA countries include TB in future DHS surveys.

2nd Conference on Innovations in Tuberculosis 2025

12 May 2025

12 May 2025