Tuberculosis incidence trends in Saudi Arabia over 20 years: 1991-2010

Abstract

OBJECTIVE:To evaluate tuberculosis (TB) incidence rates and trends over a period of 20 years (1991-2010) and assess the impact of the National TB Control Program (NTP) on incidence trends.METHODS:This is a retrospective study of TB surveillance data reported by the Ministry of Health. We evaluated TB incidence data by nationality, age, and region of the country and assessed incidence trends over 20 years of study. Chi-squared test was used to assess trend change and its significance.RESULTS:There were a total of 64,345 reported TB cases over the study period. Of these 48% were Non-Saudis. TB annual incidence rate ranged between 14 and 17/100,000. For Saudis, the rate ranged between 8.6 and 12.2/100,000. Non-Saudis had 2-3 times higher incidence. Disease trend was rising over the first 10 years of the study period then it started to fall slightly. The incidence increased with age, but only people older than 45 years showed a declining trend. Regional variations were observed. Makkah and Jazan regions had the highest incidence rates. Disease trends were rising over the last 10 years in Makkah and Central regions.CONCLUSION:TB control seems to be facing some challenges in several regions of the Kingdom. NTP needs to evaluate and improve TB control strategies in order to reduce disease incidence to elimination levels.

Poor Knowledge of Tuberculosis among the Population of Jeddah and Makkah Saudi Arabia, a High-Risk Area

“…Late diagnosis and treatment is a major problem in TB control as it facilitates the spread of the disease [2]. Therefore, our results relating to individuals' response to symptoms may be particularly troubling-i.e., many would seek help from traditional rather than modern medicine practitioners, and many would do nothing or wait before seeking any medical help at all.…”

“…BCG vaccination is compulsory at birth in KSA, and TB treatment is free in government hospitals. However, the western region including Makkah and Jeddah has an incidence of 24/100,000, which is well above the national average and is rising rapidly, in contrast to the pattern elsewhere across KSA [2] [3]. Other reports put the incidence in this region as high as 64/100,000 [9].…”

“…There is obvious potential for TB transmission from pilgrims to the local population with whom they are in frequent contact. Some non-Saudi pilgrims remain in the Makkah region for work, but tend to have poor healthcare and housing because of fear of deportation; it is considered likely that they contribute to the high incidence of TB in this region [2]. Furthermore, studies have highlighted significant positive TST rates among healthcare workers in KSA, which represents another potential route of transmission [11].…”

“…Millions of pilgrims each year come from outside KSA [1], and over 50% from regions where tuberculosis is endemic, such as India, Pakistan, Bangladesh, southeast Asia and Africa. Asia and Africa account for 85% of global TB cases [2]. The Hajj represents a major infection challenge with few global equivalents.…”

Diagnostic Accuracy of IS6110 Insertion Gene, <i>Hsp65</i>, and Xpert MTB/RIF for Rapid Diagnosis of Pulmonary Tuberculosis

“…Several predisposing factors such as the high economic living in Saudi Arabia, attract many workers from affected areas, and also the frequent visit of pilgrims to the holy cities [2] [3] [4].…”