Active and latent tuberculosis in refugees and asylum seekers: a systematic review and meta-analysis

Proença, Raquel; Souza, Fernanda Mattos de; Bastos, Mayara Lisboa; Caetano, Rosângela; Braga, José Ueleres; Faerstein, Eduardo; Trajman, Anete

doi:10.21203/rs.2.17241/v2

Cited by 3 publications

(5 citation statements)

References 20 publications

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“…Majority (>86%) of refugees are from and stay within developing countries where the TB burden is higher [12]. Studies have shown an increase in the prevalence of TB [13,14] and TB case notification [14,15] when the number of refugee population increases. Thus, key populations such as refugees have been given special focus in the Stop TB [16] and End TB [2] WHO strategic documents so as to achieve the global targets by 2035.…”

Section: Introductionmentioning

confidence: 99%

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Trends of Tuberculosis Treatment Outcomes of Notified Cases in Three Refugee Camps in Sudan: A Four-year Retrospective Analysis, 2014–2017

Legesse¹,

Elduma²,

Awad

et al. 2021

SJMS

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Background: Refugees are vulnerable to tuberculosis (TB) infection. Tracking of program performance is needed to improve TB care and prevention. The objective of this study was to assess the trends of TB treatment outcomes of notified cases in three refugee camps in Sudan from 2014 to 2017. Methods: This study was a historical cohort study. Sex, age, type of TB, TB patient category, and treatment outcome of all TB cases registered in three refugee camps (Al Kashafa, Shagarab, Wadsherify) from January 1, 2014 to December 31, 2017 were collected from the TB register. Multivariable logistic regression was performed to explore factors for unsuccessful TB treatment. Results: A total of 710 TB cases of which 53.4% were men, 22.1% children (<15 years), and 36.2% extrapulmonary TB (EPTB) were registered. Overall, the TB treatment success rate was 75.7% with a declining trend from 86.2% in 2015 to 63.5% in 2017. On average, 11.4% were lost to follow-up (LTFU), 6.6% died, 5.9% were not evaluated, and in 0.3% the treatment failed. Being 15–24 years old and having EPTB were significantly associated with unsuccessful treatment outcome. Conclusion: The treatment success rate in the refugee camp in 2017 (63.5%) was far lower than the national treatment success rate (78%) and the End TB global target (≥90%) that needs to be improved. LTFU, died, and not evaluated outcomes were high which indicated the necessity to improve the TB treatment program.

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Section: Introductionmentioning

confidence: 99%

“…The aforementioned pieces of evidence [13][14][15][16][17] indicate that TB is one of the main health problems in the refugee camps of Sudan. Hence, periodic review of TB program performance in the refugee camps is needed to address the gaps and improve the implementation of TB care and prevention program.…”

Section: Introductionmentioning

confidence: 99%

Trends of Tuberculosis Treatment Outcomes of Notified Cases in Three Refugee Camps in Sudan: A Four-year Retrospective Analysis, 2014–2017

Legesse¹,

Elduma²,

Awad

et al. 2021

SJMS

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“…The total end year refugee population in Ethiopia was continuously increased from 491030 in 2014 to 728000 by 2017. The highest refugee population by 2017 were in Gambella refugee area (219,708), followed by Dollo Ado (197.952), Shire (109, 360), Asossa (55.726), Jijiga (35,024), Afar (15.390), and Mizan (11,761) [15].…”

Section: Study Settingsmentioning

confidence: 99%

“…Usually, majority (> 85%) of refugees originate from and remain within countries with high burdens of TB [10]. However, according to a recent systemic review and meta-analysis, TB prevalence in refugees and asylum seekers varied more according to countries of origin than the host continent [11]. Other also reported, an association between immigration and increased prevalence of either TB or EPTB [12].…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis (TB) in the refugee camps in Ethiopia: Trends of case notification, profile, and treatment outcomes, 2014 to 2017

Legesse

Admenur

Gebregzabher

et al. 2020

Preprint

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Background: Severity of TB increases in refugee populations. Monitoring TB case notification and treatment outcomes are essential to improve the effectiveness of TB programs. This study aimed to investigate trends in TB case notification and treatment outcomes and explore factors associated with unsuccessful treatment outcome in refugee camps in Ethiopia. Methods: In this retrospective cohort study, demographic and clinical data of all TB cases registered in 25 refugee camps in Ethiopia from January 2014 to December 2017 were extracted. Multivariate logistic regression was fitted to estimate odds ratios and corresponding 95% confidence intervals for the measure of association linked with factors significantly associated with unsuccessful treatment outcomes. Results: A total of 1553 TB cases, mean age 27.7 years, were registered from 2014 to 2017. Of these notified cases 54.7% were men, 27.7% children (< 15 years), 71.2% pulmonary TB (PTB), 27.8% Extra-PTB (EPTB) and 98.3% new and relapse. From 2014 to 2017: there was consistent increase in number of notified TB cases (138 to 588 cases), in percentage of EPTB (23.2% to 32.7%), in contribution of children to total TB cases (18.8% to 30.1%) and to EPTB (40.6% to 65.1%), and in proportion of bacteriologically confirmed new and relapse pulmonary cases (43.8% to 64.8%). Treatment success rates for all TB cases remained lower at 72.7%-79.4%. On average 24.8% had unfavorable treatment outcome, including 11.5% not evaluated, 8.0% LTFU, 4.8% died and 0.5% treatment failed. Unsuccessful treatment was significantly associated with pretreatment weight below 40 Kg, age over 45 years, and being HIV positive. Conclusions: There was continuous increase in notified TB cases and in percentage of childhood TB. Proportion of bacteriologically confirmed new and relapse pulmonary cases increased overtime. TB treatment success remained lower than the national achievement in 2017 (96%) and global target (>=90%), which needs improvement. The higher LTFU, not evaluated, and death suggests the need to strengthen adherence education and supervision. Special socio-economic support and monitoring is required for patients with pretreatment weight below 40 Kg, age over 45 years and HIV positives.

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“…Usually, majority (> 85%) of refugees originate from and remain within countries with high burdens of TB [10]. A recent systemic review and meta-analysis showed that TB prevalence in refugees and asylum seekers varied more according to countries of origin than the host country [11], whereas others reported association between continuous immigration (increase in migrant population) and increase in prevalence of PTB and EPTB [12], in TB case noti cation [13] and in case detection rate [14].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Tuberculosis Cases Notification and Treatment Outcomes Among Refugee Camps In Kenya: Four Year Retrospective Study, 2014-2017

Legesse

Mulesh

Anjuri

et al. 2020

Preprint

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Background: Tuberculosis (TB) is more severe in refugee populations. Analyzing the key indicators of TB program performance is important to improve the effectiveness of TB control in the refugee camps. This study aimed to analyze trends in TB case notification, treatment outcomes and factors associated with unsuccessful TB treatment in Dadaab and Kakuma refugee camps in Kenya. Methods: In this descriptive retrospective study, demographic and clinical data all TB cases registered in the refugee camps from January 2014 to December 2017 were extracted. Multiple logistic regression analysis was used to estimate odds ratios and 95% confidence intervals for variables associated with unsuccessful TB treatment.Results. A total of 2055 TB cases of whom 56.8% men and 57.7% age 15-44 years were registered. Number of notified cases decreased from 532 in 2014 to 473 in 2016 (11.1% decrease) then increased to 554 in 2017(16.9% increase in one year). From 2014 to 2017 there was consistent increase in percentage of EPTB (16.2% to 21.1%), and in contribution of children (<15 years) to total TB cases (20.3% to 25.8%) and to EPTB (36.1% to 44.4%). Proportion of bacteriologically confirmed new and relapse pulmonary cases increased from 49.5% to 60.9%. Treatment success rate remained higher at 92.6% to 94.4%. On average 41.7% were cured, 2.3% lost to follow-up (LTFU) (increasing from 1.3% to 3.2%), 2.2% died (decreasing from 2.4% to 1.6%), 1.6% not evaluated (decreasing from 3.2% to 1.3%), and 0.5% treatment failed. Unsuccessful treatment outcome was significantly associated with pretreatment weight < 40 Kg, being male, smear positive PTB, HIV infection, and age >15 years (increased with age).Conclusions: Number of notified TB cases has decreased from 2014 to 2016, but increased in 2017. There was continuous increase in percentage of EPTB and childhood TB. Proportion of bacteriologically confirmed new and relapse pulmonary cases has increased overtime. Treatment success remained higher above global target (90%) which should be maintained. Special socioeconomic support and follow-up is required for TB patients who are at higher risk of unsuccessful treatment.

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Active and latent tuberculosis in refugees and asylum seekers: a systematic review and meta-analysis

Cited by 3 publications

References 20 publications

Trends of Tuberculosis Treatment Outcomes of Notified Cases in Three Refugee Camps in Sudan: A Four-year Retrospective Analysis, 2014–2017

Trends of Tuberculosis Treatment Outcomes of Notified Cases in Three Refugee Camps in Sudan: A Four-year Retrospective Analysis, 2014–2017

Tuberculosis (TB) in the refugee camps in Ethiopia: Trends of case notification, profile, and treatment outcomes, 2014 to 2017

Analysis of Tuberculosis Cases Notification and Treatment Outcomes Among Refugee Camps In Kenya: Four Year Retrospective Study, 2014-2017

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