1. KEY FINDINGS Poverty level among TB patients 62 percent of patients within the sample were poor (95% CI: 55-69%) The general urban population Lilongwe poverty headcount 37.8 percent (IHS) Livelihood patterns of poor and non-poor and impact of illness Poor people were characterised as:  Living in poorly ventilated and constructed houses  Having few assets assets (e.g.  Earning income from casual labour (ganyu), petty trading, or unskilled labour  Being food insecure Non-poor people were characterised as:  Having adequate food  Earning income from medium or large scale businesses, working in the public and private sectors  Living in better houses (e.g. having an iron-sheet roof) The major shock to the livelihoods of the poor which was mentioned was ill health TB patients experience Individual interviews with patients revealed a similar pattern of impact of ill health compared to data from the participatory poverty assessment Both poor and non-poor experienced negative consequences of TB such as difficulties in mobilizing financial resources, reduced time spent on activities, BUT the effect was greater on poor TB patients Poor patients: Sold assets (such as pots and pans) Lost income when it depended on the daily input of labour Took on local loans at a high interest rate Missed meals or were unable to purchase tap water from the communal tap Non-poor patients were able to mitigate the economic impact of the illness by drawing upon saving or valuable assets. CONCLUSION TB patients are generally poorer than the general population and the impact of TB is greatest on the poor. DOTS programmes need to respond to the needs of poor people by reducing the impact of TB on their livelihoods, for example by ensuring diagnostic and treatment services for TB are located within poor communities. HIV/AIDS is not the only challenge facing DOTS programmes in sub-Saharan Africa – poverty remains a key issue METHODOLOGY 1 Development of a proxy measure of poverty from the Integrated Household Survey Regression analysis was conducted on the 1998 Integrated Household Survey (IHS) sample for urban Lilongwe using the welfare level as the dependent variable. A model was developed consisting 13 variables selected based on the criteria of their significant contribution to the welfare of an individual or household. The tool was tested on the IHS sample to assess its’ power to predict the socio-economic status of an individual The tool was then applied to a random sample of 179 new TB patients receiving treatment from the 6 urban TB clinics The Malawi Equi-TB Knowledge Programme is a collaboration between: Liverpool School of Tropical Medicine, National TB Programme, Malawi and Department of Sociology, University of Malawi Funded by the Department for International Development (DFID), UK METHODOLOGY 2 2. Assessment of the impact of TB on the livelihoods of TB patients A Participatory Poverty Assessment, based on a livelihood framework (DFID, 1999), was conducted in poor and non-poor areas of Lilongwe to determine livelihood patterns, and the impact of ill health on their lives 12 poor and non-poor patients (men and women) were purposively sampled from the survey participants Individual in depth interviews were conducted to assess impact of TB on their lives using the livelihood framework Sensitivity and Specificity Test Proxy measure IHS PoorNon-poor Poor40 (71%)71 (21%) Non-poor16 (29%)102 (79%) IHS Sample =229 Chi-square= 15 P<0.001 BACKGROUND Malawi has had a coherent DOTS programme for more than a decade. Drugs, consultations and diagnostic test are free at the point of delivery in the public service. Nonetheless, TB notifications continue to rise, fuelled by an HIV/AIDS epidemic. It is estimated that 77% of TB patients in Malawi are HIV positive (Kwanjana et al., 1999). Little is known about whether, in light of the HIV/AIDS epidemic, poverty is still an issue for TB control in Malawi. “Because I stopped doing petty business of selling knitted children clothing. Now I depend on my sister who does is also involved in petty trading. I have 3 children to look after” (Poorwoman3). OBJECTIVES  To compare the prevalence of poverty between TB patients and the general population  To assess the impact of TB on lives of poor and non-poor patients Variables within the model Sex of head of household Number of dependents Household size Head of household education Professional or managerial workers Government employee Education level for patient Use of public tap Use purchased firewood Use electricity for lighting Have TV Have car Live in medium density areas “ It is difficult to find money and sometimes you sell assets for the households. If you are sick and need nutritious food you sell assets like clothes, chairs. This exacerbates poverty within the family” (KUMan) “Since the illness we stopped buying a whole bag of maize per month, instead we buy a pail of maize. It is now several months since we stopped using the public water tap because we cannot pay, we now use water from the traditional well (poorwoman-2). Address: 1 Equi-TB Knowledge Programme, Lilongwe, Malawi 2 International Food Policy Research Institute, Washington, USA 3 Department of Sociology, University of Malawi, 4 National TB Control Programme, Lilongwe, Malawi. 5 Liverpool School of Tropical Medicine, Liverpool, UK. DOTS IS NOT ENOUGH; POVERTY IS STILL AN ISSUE FOR TB CONTROL IN MALAWI Nhlema B 1, Benson T 2, Kishindo P 3, Salaniponi FML 4, Squire SB 1,5, Kemp J 1,5