Ethnic disparities in tuberculosis incidence and related factors among indigenous and other communities in ethnically diverse Suriname

Abstract

Background In Suriname, a country home to many ethnic groups, a high incidence of tuberculosis (TB) has been found among Indigenous Trio Amerindians. However, whether wider ethnic disparities in TB incidence and its associated risk factors (e.g., diabetes mellitus and HIV) exist in Suriname, is not known. We sought to investigate disparities in TB incidence and its risk factors on ethnicity in Suriname, as this could give way to targeted TB intervention programs. Methods Anonymized patient data from 2011 to 2015 was extracted from the National TB Registry and analyzed. Differences in the five-year incidence rates of TB for the six largest ethnic groups—Creole, Hindustani, Indigenous, Javanese, Maroon, and Mixed—were assessed using a chi-square goodness-of-fit test, and TB patient differences regarding ethnicity were evaluated for selected factors using a multinomial logistic regression with Creole patients as reference. Results 662 Patients were eligible for analyses with the following ethnic makeup: Creole (36.4%), Hindustani (15.6%), Indigenous (8.6%), Javanese (10.6%), Maroon (15.1%), and Mixed ethnicity (13.7%). Differences in five-year incidence rates for TB were significant, χ 2 (5, N = 662) = 244.42, p < .001, and the highest TB rates were found for Indigenous (280 per 100,000) and Creole people (271 per 100,000). HIV coinfection was a TB risk factor for Creoles (38.2% of these patients were HIV positive). Several variables (i.e., those for drug use) had high levels of incomplete or missing data. Conclusions Our study has demonstrated that ethnic disparities in tuberculosis incidence exist in Suriname and that they are associated with specific, known risk factors such as HIV (especially for Creole people). For Indigenous people, risk factors may include diminished access to health care facilities and low socioeconomic status. However, direct data on these factors was unavailable. These findings call for targeted national intervention programs—with special attention given to the vulnerabilities of susceptible ethnic groups—and improved data collection.

Assessing intersectional gender analysis in Nepal’s health management information system: a case study on tuberculosis for inclusive health systems

“…However, various studies conducted in other countries have shown that the migrant population and ethnic minorities have a higher prevalence of TB in comparison to the general population [ 49 – 53 ]. This could be because of interactions between cultural and structural barriers to accessing healthcare [ 3 , 4 , 50 – 53 ]. Behind this, social power and structures have influenced vulnerability and treatment outcome of TB among people living in slums and densely populated urban settings, people living in congregate settings like factories, prisons, camps and refugees [ 44 ].…”

Intersectional gender analysis for inclusive health system in Nepal: taking Tuberculosis as a case example

“…Our study did not identify significant differences in TB related outcomes across ethnic groups. However, various studies conducted in other countries have shown that migrant population and ethnic minorities have higher prevalence of TB in comparison to general population [49][50][51][52][53]. This could be because of interactions between cultural and structural barriers to accessing healthcare [3,4,[50][51][52][53][54].…”

“…However, various studies conducted in other countries have shown that migrant population and ethnic minorities have higher prevalence of TB in comparison to general population [49][50][51][52][53]. This could be because of interactions between cultural and structural barriers to accessing healthcare [3,4,[50][51][52][53][54]. Behind this, social power and structures have influenced vulnerability and treatment outcome of TB among people living in slums and densely populated urban settings, people living in congregate settings like factories, prisons, camps and refugees [44].…”

Indications, Interpretation and Clinical Consequences of Tuberculin Skin Tests in Resource Limited Settings

“…If this test is negative, initiation or continuation of ART should be advised. This advice is based on our finding that most HIV infected TB patients in Suriname have low CD4 counts and/or are not using ART [21].…”