Characterization of tuberculosis (TB) in Lebanon: epidemiology and risk factors for extrapulmonary TB Público

Abstract

Characterization of tuberculosis (TB) in Lebanon: epidemiology and risk factors for extrapulmonary TB

Lana C. O'Son, MD, MPH, Erin N. Hulland, MPH, Susan T. Cookson, MD, MPH, Kenneth G. Castro, MD, Hiam Yaacoub, MD

Introduction: Lebanon is working to strengthen their National Tuberculosis Programme (NTP), and in 2014 began collecting more detailed data on their cases. We analyzed the data to identify risk factors for developing extrapulmonary tuberculosis (EPTB) and to assess the impact of Syrian refugees on rates of TB in Lebanon.

Methods: Line list data of all cases reported to the Lebanese NTP between 2014-2015 were extracted. To test for differences between pulmonary (PTB) and EPTB, Chi-square tests and Student's T-tests were performed. Factors significantly associated with EPTB were assessed using stepwise multivariable logistic regression models comparing EPTB cases with PTB cases. To evaluate trends, aggregate TB data from 2011-2013 were assessed in conjunction with the 2014 and 2015 line listed data.

Results: For 2014-2015, 1347 cases were reported; of those, 507 (37%) were EPTB cases. Combined with the aggregate data, the overall TB and EPTB numbers stabilized. The proportion of all TB cases among Syrians increased from 3% in 2011 to 29% in 2015 (overall median=15%) of cases; however, the proportion of EPTB cases among Syrians decreased relative to Lebanese in these same years (2011: 33%, 2015: 24%, overall median=30%). Given the limited number of complete variables (i.e., gender, age, nationality), all were put into a multivariable logistic regression model and were found to be independent risk factors for having EPTB: female (OR: 1.79, 95% CI: 1.34-2.67), Lebanese (OR: 2.43, 95% CI: 1.85-3.18), and ages 5-15 years old (OR: 3.05, 95% CI: 1.33-6.98) ( >15 years old [OR: 2.43, 95% CI: 1.85-3.18]).

Conclusions: Syrians had an increasing contribution to overall TB rates in Lebanon; however, their proportional contribution to EPTB decreased. Given the high rates of EPTB among Lebanese, additional reasons, such as prevalence of chronic diseases and immunosuppression, and etiology, such as contribution of Mycobacterium bovis and BCG need exploring.

Table of Contents

Table of Contents

Chapter 1: Literature Review..............................................................1
Introduction.................................................................................1
Lebanon......................................................................................2
Epidemiology...............................................................................2
Risk Factors.................................................................................3
Clinical Manifestations...................................................................4
Diagnosis.....................................................................................5
Mycobacterium bovis and Transmission............................................6
Treatment....................................................................................6
Methods..........................................................................................7
Results............................................................................................9
Tables.........................................................................................10
Figures......................................................................................13
Discussion.......................................................................................14
Limitations...................................................................................16
Conclusion.......................................................................................17
References.......................................................................................19

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Middle Eastern Studies Health Sciences, Public Health Health Sciences, Medicine and Surgery
Palavra-chave	Tuberculosis Refugees Lebanon
Committee Chair / Thesis Advisor	Castro, Kenneth G, Emory University
Committee Members	Erin N, Hulland, Centers for Disease Control and Prevention Cookson, Susan T, Centers for Disease Control and Prevention
Partnering Agencies	International governmental organization (e.g., Agency for International Development, etc.)

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