Assessment of the Syndemic Relationship Between Individual, Social, and Structural Determinants of Tuberculosis Among People Living in Johannesburg, South Africa

Fiona Tsungirai Tanyanyiwa, Renay Helouise Van Wyk () and Keitshepile Geoffrey Setswe
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Fiona Tsungirai Tanyanyiwa: Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2006, South Africa
Renay Helouise Van Wyk: Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2006, South Africa
Keitshepile Geoffrey Setswe: Implementation Research Division, Aurum Institute, Johannesburg 2193, South Africa

IJERPH, 2025, vol. 22, issue 8, 1-15

Abstract: Tuberculosis (TB) remains a critical public health issue in Johannesburg, South Africa, driven by a complex interplay of individual, social, and structural factors. This study assessed the syndemic relationship between these determinants to understand their collective impact on TB burden and treatment outcomes. A cross-sectional survey was conducted among TB patients attending selected clinics, examining behavioural risks (e.g., smoking, alcohol use, HIV co-infection), social conditions (poverty, overcrowding, stigma), and structural challenges (access to healthcare, migration status). The results revealed a significant co-occurrence of TB and HIV (56.1%), alongside high rates of smoking (33.1%) and alcohol use (45.2%). Unemployment (50.2%), inadequate housing, and limited healthcare access, particularly for undocumented migrants (26.2%), were also prominent. Factor analysis demonstrated a syndemic interaction between behavioural and social determinants, underscoring the compounded vulnerability of affected populations. The findings highlight the necessity of integrating medical interventions with social and structural reforms. Recommendations include TB-HIV co-management, substance abuse programmes, improved housing, and inclusive healthcare access. A multisectoral approach addressing both health and socioeconomic inequalities is critical for comprehensive TB control in urban South African contexts.

Keywords: tuberculosis; syndemic theory; social determinants; behavioural risk factors; structural barriers (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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