An overview of tuberculosis and migration

Abstract

With nearly one billion migrants worldwide, migration is both a dynamic and a divisive phenomenon facing the world today. Migrants are a heterogeneous group, and the conditions surrounding migration pathways often pose risks to the physical, mental and social well-being of migrants, with certain subgroups being more vulnerable than others. Several determinants of health and tuberculosis (TB) interplay to increase the vulnerability of migrants to tuberculous infection, TB disease and poor treatment outcomes, making them a key population for TB. This article is the first in the State-of-the-Art series of the International Journal of Tuberculosis and Lung Disease on TB and migration. It provides an overview of migration trends, migration pathways and social determinants, and impact on TB. This article outlines a framework for the prevention and reduction of the TB burden among migrants, adapted from the World Health Organization's End TB Strategy, and in accordance with the Stop TB Partnership's Global Plan and the Sustainable Development Goals (SDGs) agenda. The framework highlights the need for migrant-inclusive national TB plans, and calls for action across all three pillars of the End TB Strategy for migrant-sensitive care and prevention, bold intersectoral policies and systems supportive of migrants, and operational research. More research is needed on the TB burden and challenges faced by migrants and on the feasibility and effectiveness of approaches proposed here and the scaling up of models already underway. Political commitment at the highest national and international levels will be critical to intensify action for promoting the health of migrants on the road to achieving the end TB targets.

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

“…Yet, this finding is worth highlighting: between 1990 and 2011 the tuberculosis prevalence in Syria had decreased from 85 to 23/100,000 (64). Armed conflicts and wars destroy the basic medical infrastructure, undermine health agendas and cause significant shortages of health professionals and medicines, leading the prevalence of tuberculosis to a possible underestimation (8,64). Symptoms of the active phase of tuberculosis, such as coughing and fatigue, may go unnoticed to already infected individuals and health care workers in crisis settings, because they are insidious (17).…”

“…Symptoms of the active phase of tuberculosis, such as coughing and fatigue, may go unnoticed to already infected individuals and health care workers in crisis settings, because they are insidious (17). Dangerous situations encountered during migration, including overcrowding, incarceration, malnutrition, challenges to access health care, low adherence to treatment, associated risk of HIV infection and exposure to other migrants from higher incidence countries also contribute to the risk of contamination by M. tuberculosis and progression to disease (8,(64)(65)(66).…”

Aspects related to the outcomes of the treatment, in international borders, of cases of tuberculosis as associated to comorbidities

“…These situations have become more common since, in recent years, people from South and Central America have been migrating to Brazil due to humanitarian reasons (17) . Regarding this issue, different aspects of the health/disease interaction increase the vulnerability of migrants to TB infection during transit and settling down in their destiny, usually settlements for migrants, mostly in border regions, which usually have low capabilities regarding social and health assistance, meaning not only that migrants are a population susceptible to TB, but also making it more difficult to manage the disease (18) .…”

The association between internal migration and pulmonary tuberculosis in China, 2005–2015: a spatial analysis

“…Most internal migrants in China have traveled from rural areas to prosperous economic regions to pursue higher incomes and better lifestyle opportunities [8,9]. Compared with permanent residents, internal migrants face substantial problems in accessing medical care, insurance, and social security [10]. According to previous studies, migrants are more vulnerable due to low income, poor working and living conditions, less education, and poor awareness of health protection [11][12][13].…”