The Burden of Tuberculosis Among Acute Emergency-Affected Displaced Populations Open Access

Tate, Anna (2015)

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Background: A large proportion of the world's population is affected by disasters, both natural and man-made. By 2013, there were 51.2 million people forcibly displaced. Little is known about the burden of tuberculosis (TB) among displaced persons. And quantification of the TB burden in this population is needed with potential implication to prevent TB-associated morbidity and mortality during humanitarian emergencies.

Methods: Data from countries with emergencies in 2009, 2011, and 2013 resulting in ≥ 50,000 newly internally displaced persons (IDPs) and population estimates of IDPs, newly returning IDPs and newly-returning refugees were used to determine the number of cases of TB and the proportion of TB burden. Estimates were then aggregated by WHO region, emergency type, and World Bank country economic classification.

Results: Forty-five countries fit the case definition with a total displaced population ranging from 17,814,666 in 2009 to 29,906,491 in 2013. Most experienced both conflicts and natural disasters in the 3-year study period, with the African Region accounting for the most (n=18). Natural disasters produced the greatest number of new IDPs (>35 million) and the greatest number of IDPs with TB (55,846). Although countries experiencing conflict only did not have the greatest number of IDPs (>19 million), the burden of TB was greatest in these countries, with IDPs accounting for 1.8% of the TB burden compared with 0.4% for natural disasters and 1.6% for both emergencies. The proportion of TB burden paralleled the World Bank's economic classifications, with 0.03% TB burden among IDPs in high-income countries, 0.32% upper-middle, 0.94% lower-middle, and 1.32% in low-income countries.

Discussion: These estimates illustrate the high TB burden among emergency-displaced populations. The most notable finding was the 4-fold greater TB burden among IDPs from conflicts as compared to natural disasters. New IDPs have disrupted TB care and treatment, necessitating the need for quick remedies to ameliorate their excess TB-related morbidity and mortality. As such, our findings underscore the importance of implementing TB control programs as soon as possible in the acute phase of an emergency.

Table of Contents

Chapter 1: Introduction...1

Chapter 2: Comprehensive Review of the Literature...3

2.1 Introduction...3

2.2 Humanitarian Crises...3

2.3 Tuberculosis Prevention and Control...4

2.4 Factors Contributing to TB...5

2.5 Prevention Measures...7

2.6 TB Control Programs...7

2.7 Conclusion...9


Chapter 3: Manuscript...18

3.1 Contribution of Student...18

3.2 Abstract...19

3.3 Introduction...20

3.4 Methods...21

3.5 Results...24

3.6 Discussion...27

3.7 Manuscript References...30

3.8 Tables and Figures...35

Chapter 4: Discussion and Public Health Implications...42

Thesis References...46

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