Factors associated with TB screening among agricultural workers in Limpopo Province, South Africa

ABSTRACT

Background

Tuberculosis (TB) continues to be a public health issue of concern in South Africa. Workers in the agricultural sector are generally at increased risk of TB due to multiple interacting factors such as exposure to silica dust, co-worker infection, and occupations falling within the lower socio-economic sectors.

Objective

This study investigates factors associated with TB screening uptake for agricultural workers in Limpopo Province, South Africa.

Method

This cross-sectional study targeted a study population of 16,787 agricultural workers across 96 agricultural worksites in South Africa. A two-stage cluster random sampling design identified 24 agricultural worksites and a potential 2500 participants. The outcome variable was self-reported TB screening. Descriptive statistics and unadjusted and adjusted logistic regression analyses were performed to determine factors associated with TB screening. A literature review informed the selection of covariates as possible confounders.

Results

The final study sample comprised 2144 workers across 24 sites, with 55% being women. TB screening uptake was 1155 (56.3%). Factors such as living with human immunodeficiency virus (HIV) (AOR 3.16, 95% CI: 2.44–4.09), accessing health services in the workplace (AOR 1.94, 95% CI: 1.09–3.46), and having prior TB knowledge (AOR 18.45, 95% CI: 9.8–34.74) were positively associated with TB screening. Participants in the age group 36–49 years had significantly higher odds of self-reporting TB screening, compared with those aged 18–25 years (AOR 1.37, 95% CI 1.07–1.77). Migrant workers from Mozambique (OR 0.52, 95% CI: 0.34–0.79) and Zimbabwe (OR 0.71, 95% CI 0.57–0.89) were significantly less likely to self-report TB screening compared to their South African counterparts.

Conclusion

The findings underscore the importance of workplace health services in achieving end-TB targets. We recommend programs and interventions for preventing TB in South Africa that target the agricultural sector in general, and in particular migrant workers.

KEYWORDS:

• Agricultural workers
• occupational health
• TB prevention
• migrant health
• access to healthcare
• workers’ health

Responsible Editor

Jennifer Stewart Williams

Responsible Editor

Jennifer Stewart Williams

Acknowledgments

We would like to thank the National Institute for Occupational Health (NIOH) and the National Health Laboratory Service (NHLS) for providing a platform, including funding, to conduct this project. We also acknowledge the South African Medical Research Council (SAMRC), Hoedspruit training trust (Hlokomela), Centre for Positive Care (CPC), and Choice Trust for collaborating with us in this research project. We further acknowledge all farmers and agricultural worksites who permitted us to conduct research within their properties. Finally, we acknowledge and express our deep gratitude to all agricultural workers who participated in this study, and to Dr Cheryl Tosh (University of Pretoria) for editing the article.

Author contributions

NM contributed to this work through conceptualization, study design, data acquisition, and interpretation of results, and drafted the manuscript. MM, FM and JR contributed to the acquisition, analysis, interpretation of data, and revision of the draft manuscript. YS, CD, and NS contributed to the conceptualization and study design, acquisition of data, and revision of the manuscript. MZ contributed to the conceptualization, study design, analysis, and interpretation of results through supervision, and the revision of the manuscript. All authors approved the final version and agree to be accountable for all aspects of this work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Written informed consent was obtained from all participants. Confidentiality was guaranteed in line with the National Department of Health Ethics in Health Research guidelines [40], the Helsinki declaration, and the study was approved by the University of Pretoria’s Faculty of Health Sciences Research Ethics Committee (392/2018). Identifiers were removed from the data presented in this study to ensure confidentiality.

Paper context

Agricultural workers are a vulnerable working population with poor access to health services. There is reportedly a high TB mortality rate within this population, but limited information on screening uptake. The results of this study indicate low TB screening, coupled with poor access to healthcare services. The study findings are important for planning TB prevention programs in the agricultural sector.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.