ArticleJournal of epidemiology and global health2026
Health-Related Quality of Life Deterioration Among Tuberculosis Patients During the COVID-19 Pandemic: a Convergent Mixed-Methods Study of Syndemic Vulnerability in Urban Bangladesh.
Article in Journal of epidemiology and global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundUnited Nations Sustainable Development Goal 3 (Target 3.3) calls for ending the tuberculosis (TB) epidemic by 2030; yet TB programmes in low-income settings remain acutely vulnerable to pandemic disruption. During the COVID-19 first wave, TB patients in urban Bangladesh faced a convergence of disease burden, pandemic-related stressors, and poverty-driven resource constraints. Systematic evidence quantifying health-related quality of life (HRQoL) deterioration in this population and identifying its modifiable structural determinants is limited.
methodsA convergent parallel mixed-methods study was conducted among 439 TB patients attending 12 Directly Observed Treatment, Short-course (DOTS) clinics across six municipal districts in Dhaka, Bangladesh, between August and September 2020. HRQoL was measured with the EQ-5D-3L and post-traumatic stress with the Impact of Event Scale-Revised (IES-R). Multinomial logistic regression identified factors independently associated with HRQoL deterioration. Concurrently, 36 semi-structured in-depth interviews were analysed using Braun and Clarke's thematic analysis framework.
resultsPain or discomfort was reported by 46.5% of participants (95% CI: 41.9-51.1%) and anxiety or depression by 36.9% (95% CI: 32.5-41.5%). On multivariable analysis, anxiety/depression was independently associated with larger household size (adjusted OR = 1.08 per person; 95% CI: 1.03-1.14; p = 0.002), greater distance to the DOTS clinic (adjusted OR = 1.03 per km; 95% CI: 1.01-1.05; p < 0.001), and appointment intervals of ≤ 14 days versus 15-30 days (adjusted OR = 2.86; 95% CI: 1.33-7.14; p = 0.011). Drug-resistant TB was strongly associated with activity limitation (adjusted OR = 27.7; 95% CI: 8.3-92.4). Qualitative analysis identified three themes: stigma intensification through symptom conflation with COVID-19; economic hardship obstructing treatment adherence and nutrition; and perceived inadequacy of government relief for chronically ill populations.
conclusionsIn this cross-sectional study, HRQoL deterioration among urban TB patients in Bangladesh during the COVID-19 pandemic was significantly associated with modifiable structural factors. These preliminary findings suggest that appointment scheduling optimisation, service decentralisation, nutritional support, and psychosocial services may reduce pandemic-era HRQoL burden. Prospective longitudinal studies are needed to establish causality and inform programme design.
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