Migration to middle-income countries and tuberculosis—global policies for global economies

Abstract

BackgroundInternational migration to middle-income countries is increasing and its health consequences, in particular increasing transmission rates of tuberculosis (TB), deserve consideration. Migration and TB are a matter of concern in high-income countries and targeted screening of migrants for active and latent TB infection is a main strategy to manage risk and minimize transmission. In this paper, we discuss some aspects of TB control and migration in the context of middle-income countries, together with the prospect of responding with equitable and comprehensive policies.Main bodyTB rates in middle-income countries remain disproportionally high among the poorest and most vulnerable groups in large cities where most migrant populations are concentrated. Policies that tackle migrant TB in high-income countries may be inadequate for middle-income countries because of their different socio-economic and cultural scenarios. Strategies to control TB in these settings must take into account the characteristics of middle-income countries and the complexity of TB as a disease of poverty. Intersectoral policies of social protection such as cash-transfer programs help reducing poverty and improving health in vulnerable populations. We address the development of new approaches to improve well-established strategies including contact tracing and active and latent TB screening as an ‘add on’ to the existing health care guidelines of conditional cash transfer programs. In addition, we discuss how it might improve health and welfare among both poor migrants and locally-born populations. Authorities from middle-income countries should recognise that migrants are a vulnerable social group and promote cooperation efforts between sending and receiving countries for mitigation of poverty and prevention of disease in this group.ConclusionsMiddle-income countries have long sent migrants overseas. However, the influx of large migrant populations into their societies is relatively new and a growing phenomenon and it is time to set comprehensive goals to improve health among these communities. Conditional cash transfer policies with TB screening and strengthening of DOTS are some strategies that deserve attention. Reduction of social and health inequality among migrants should be incorporated into concerted actions to meet TB control targets.

Multiple Introductions of Mycobacterium tuberculosis Lineage 2–Beijing Into Africa Over Centuries

“…These activities also brought many Chinese workers to Africa during a time when TB was still very prevalent in China (Murray, 2018). Hence, many of these workers were likely latently infected with L2-Beijing and might have later reactivated (Pescarini et al, 2017). Overall, our findings suggest that L2-Beijing has emerged in Africa over the last 300 years and that these introductions have occurred sporadically ever since.…”

Socio-economic status and risk of tuberculosis: a case-control study of HIV-infected patients in Asia

“…Furthermore, our study also shows that there was a weak association between patients who were currently living in their place of origin and TB, compared to patients who have moved from another province. It is known that migrants from high TB-burden countries are at increased risk of TB (27). However, we suspect that the HIV-positive patients in our study group who internally migrated from another province, may have been in better physical health compared to those who have stayed or returned home (28), and therefore were less susceptible to contracting TB.…”

Association of Notified Cases and Treatment Success Rates in Pulmonary Tuberculosis

“…An issue not evaluated in this paper was the effect of migration since it has been considered to increase TB transmission rates. Migrants are a target for screening for active and latent TB infection as a main strategy to manage risk and minimize transmission 21 . This is more likely the reason why most new PTB cases are detected in the northern states across the country.…”