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Legesse, T., Elduma, M. H., Awad, N. M., Elhag, M. S., Abushama, I., Mustafa, H., Hahim, K., Mahmoed, H., Mohamed, Y., Dafalla, A. E., Alwan, F., & kassa, D. (2021). Trends of Tuberculosis Treatment Outcomes of Notified Cases in Three Refugee Camps in Sudan: A Four-year Retrospective Analysis, 2014–2017. Sudan Journal of Medical Sciences (SJMS), 16(2), 259–275. https://doi.org/10.18502/sjms.v16i2.9293
https://doi.org/10.18502/sjms.v16i2.9293
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Tsegay Legesse
Tsegay Legesse
Inter-Governmental Authority on Development, Djibouti
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Mohammed Hussein Elduma
Mohammed Hussein Elduma
Inter-Governmental Authority on Development, Djibouti
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Nagi Masoud Awad
Nagi Masoud Awad
National TB program, Federal Ministry of Health, Sudan
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Mousab Siddig Elhag
Mousab Siddig Elhag
Communicable and Non-Communicable Disease Department (DCD), Federal Ministry of Health, Sudan
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Israa Abushama
Israa Abushama
National TB program, Federal Ministry of Health, Sudan
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Hamdan Mustafa
Hamdan Mustafa
2National TB program, Federal Ministry of Health, Sudan
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Kabashi Hahim
Kabashi Hahim
Communicable and Non-Communicable Disease Department (DCD), Federal Ministry of Health, Sudan
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Hassan Mahmoed
Hassan Mahmoed
TB programme, White Nile, Sudan
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Yassen Mohamed
Yassen Mohamed
TB programme, Kassala, Sudan
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Ahmed E. Dafalla
Ahmed E. Dafalla
UNHCR Office, Sudan
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Fathia Alwan
Fathia Alwan
Inter-Governmental Authority on Development, Djibouti
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Desta kassa
Desta kassa
Inter-Governmental Authority on Development, Djibouti
Published Date
- Jun 30, 2021
Trends of Tuberculosis Treatment Outcomes of Notified Cases in Three Refugee Camps in Sudan: A Four-year Retrospective Analysis, 2014–2017
Abstract
Background: Refugees are vulnerable to tuberculosis (TB) infection. Tracking of program performance is needed to improve TB care and prevention. The objective of this study was to assess the trends of TB treatment outcomes of notified cases in three refugee camps in Sudan from 2014 to 2017.
Methods: This study was a historical cohort study. Sex, age, type of TB, TB patient category, and treatment outcome of all TB cases registered in three refugee camps (Al Kashafa, Shagarab, Wadsherify) from January 1, 2014 to December 31, 2017 were collected from the TB register. Multivariable logistic regression was performed to explore factors for unsuccessful TB treatment.
Results: A total of 710 TB cases of which 53.4% were men, 22.1% children (<15 years), and 36.2% extrapulmonary TB (EPTB) were registered. Overall, the TB treatment success rate was 75.7% with a declining trend from 86.2% in 2015 to 63.5% in 2017. On average, 11.4% were lost to follow-up (LTFU), 6.6% died, 5.9% were not evaluated, and in 0.3% the treatment failed. Being 15–24 years old and having EPTB were significantly associated with unsuccessful treatment outcome.
Conclusion: The treatment success rate in the refugee camp in 2017 (63.5%) was far lower than the national treatment success rate (78%) and the End TB global target (≥90%) that needs to be improved. LTFU, died, and not evaluated outcomes were high which indicated the necessity to improve the TB treatment program.
Keywords:
refugees, Sudan, treatment outcome, tuberculosis
References
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[22] Legesse, T., Admenur, G., Gebregzabher, S., et al. (2021). Tuberculosis (TB) in the refugee camps in Ethiopia: trends of case notification, profile, and treatment outcomes, 2014 to 2017. BMC Infectious Diseases, vol. 21, article 139.
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[25] Sukrakanchana-Trikham P, Pue´chal X, Rigal J, Rieder HL. (1992).10-year assessment of treatment outcome among Cambodian refugees with sputum smear-positive tuberculosis in Khao-l-Dang, Thailand. Tuber Lung Dis. vol. 73, no. 6, pp 38–47.
[26] Minetti, A., Camelique, O., Hsa Thaw, K., et al. (2010). Tuberculosis treatment in a refugee and migrant population: 20 years of experience on the Thai-Burmese border. International Journal of Tuberculosis and Lung Disease, vol. 14, no. 12, pp. 1589–1595.
[27] Rutta, E., Kipingili, R., Lukonge, H., et al. (2001). Treatment outcome among Rwandan and Burundian refugees with sputum smear-positivetuberculosis in Ngara, Tanzania. International Journal of Tuberculosis and Lung Disease, vol. 5, no. 7, pp. 628–632.
[28] Boyd, A. T., Cookson, S. T., Almashayek, I., et al. (2019). An evaluation of a tuberculosis case-finding and treatment program among Syrian refugees—Jordan and Lebanon, 2013–2015. BMC Infectious Diseases, vol. 13, article 32.
[29] Ministry of Health (MOH), Sudan. (2018). National TB Management Guideline. MOH, Sudan.
[30] WHO. (2013). Definitions and Reporting Framework for Tuberculosis – 2013 Revision.
[31] Hassanain, S. A., Edwards, J. K., Venables, E., et al. (2018). Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004–2014. Conflict and Health, vol. 12, article 18.
[32] Yang, Z., Kong, Y., Wilson, F., et al. (2004). Identification of risk factors for extrapulmonary tuberculosis. Clinical Infectious Diseases, vol. 38, no. 2, pp. 199–205.
[33] Zhang, X., Andersen, A. B., Lillebaek, T., et al. (2011). Effect of sex, age, and race on the clinical presentation of tuberculosis: a 15-year population-based study. American Journal of Tropical Medicine and Hygiene, vol. 85, no. 2, pp. 285–290.
[34] Manabe, Y. C., Dannenberg, A. M., Jr., Tyagi, S. K., et al. (2003). Different strains of Mycobacterium tuberculosis cause various spectrums of disease in the rabbit model of tuberculosis. Infection and Immunity, vol. 71, no. 10, pp. 6004–6601.
[35] Dogar, O. F., Shah, S. K., Chughtai, A. A., et al. (2012). Gender disparity in tuberculosis cases in eastern and western provinces of Pakistan. BMC Infectious Diseases, vol. 12, article 244.
[36] Severo, N. P., Leite, C. Q., Capela, M. V., et al. (2007). Clinical and demographic characteristics of patients hospitalized with tuberculosis in Brazil between 1994 and 2004. Jornal Brasileiro de Pneumologia, vol. 33, no. 5, pp. 565–571.
[2] World Health Organization (2015). The End TB Strategy. Geneva: World Health Organization. Retrieved from: https://www.who.int/tb/strategy/end-tb/en/
[3] Kimbrough, W., Saliba, V., Dahab, M., et al. (2012). The burden of tuberculosis in crisis-affected populations: a systematic review. Lancet Infectious Diseases, vol. 12, no. 12, pp. 950–965.
[4] WHO. (2016, May 10–11). Interregional Workshop for Tuberculosis Control and Care Among Refugees and Migrant Populations. Catania, Italy: WHO. Retrieved from: http://www.euro.who.int/__data/assets/ pdf_file
[5] Nuzzo, J. B., Golub, J. E., Chaulk, P., et al. (2015). Postarrival tuberculosis screening of high-risk immigrants at a local health department. American Journal of Public Health, vol. 105, no. 7, pp. 1432– 1438.
[6] Greenaway, C., Sandoe, A., Vissandjee, B., et al. (2011). Tuberculosis: evidence review for newly arriving immigrants and refugees. CMAJ, vol. 183, no. 12, pp. E939–E951.
[7] Acosta, C. D. (2014). Conflict and drug-resistant tuberculosis in Ukraine. Lancet, vol. 384, no. 9953, pp. 1500–1501.
[8] Ejeta, E., Beyene, G., Balay, G., et al. (2018). Factors associated with unsuccessful treatment outcome in tuberculosis patients among refugees and their surrounding communities in Gambella Regional State, Ethiopia. PLoS ONE, vol. 13, no. 10, p. e0205468.
[9] Dogru, S. and Doner, P. (2017). Frequency and outcomes of new patients with pulmonary tuberculosis in Hatay province after Syrian civil war. Indian Journal of Tuberculosis, vol. 64, no. 2, pp. 83–88.
[10] Njuki, C. and Abera, W. (2018). Forced displacement and mixed migration challenges in the IGAD region. GREAT Insights Magazine, vol. 7, no. 1.
[11] United Nations High Commissioner for Refugees (UNHCR). (2019). Global Trends: Forced Displacement in 2018. Geneva: UNHCR. Retrieved from: https://www.unhcr.org/5d08d7ee7.pdf
[12] WHO. (1997). Tuberculosis Control in Refugee Situations: An Inter-agency Field Manual. WHO. Retrieved from: https://www.unhcr.org/publications/operations/3c47f5eb5/tuberculosis-controlrefugee-situations-inter-agency-field-manual.html
[13] Proença, R., Souza, F. M., Bastos, M. L., et al. (2020). Active and latent tuberculosis in refugees and asylum seekers: a systematic review and meta-analysis. BMC Public Health, vol. 20, article 838.
[14] World Health Organization, International Organization for Migration, and Ministry of Health of Lebanon. (2015). Joint Review of the National Tuberculosis Programme of Lebanon.
[15] United Nations High Commissioner for Refugees (UNHCR). (2013). Public Health Strategy for Tuberculosis among Syrian Refugees in Jordan.
[16] World Health Organization. (2006). Stop TB Strategy. Geneva: World Health Organization.
[17] UNHCR. (2014–2020). Global Focus, End Year Report, 2014–2020. Retrieved from: https://reporting. unhcr.org/node/2535
[18] Centers for Disease Control. (1992). Famine-affected, refugee, and displaced populations: recommendations for public health issues. MMWR, vol. 41, no. RR-13.
[19] World Health Organization (WHO). (2018). Compendium of WHO Guidelines and Associated Standards: Ensuring Optimum Delivery of the Cascade of Care for Patients with Tuberculosis (2nd ed.). Geneva: WHO.
[20] Vo, L. N. Q., Codlin, A. J., Forse, R. J., et al. (2020). Tuberculosis among economic migrants: acrosssectional study of the risk of poor treatment outcomes and impact of a treatment adherence intervention among temporary residents in an urban district in Ho Chi Minh City, Vietnam. BMC Infectious Diseases, vol. 20, no. 1, p. 134.
[21] Sukrakanchana-Trikham, P., Pue´chal, X., Rigal, J., et al. (1992). 10-year assessment of treatment outcome among Cambodian refugees with sputum smear-positive tuberculosis in Khao-l-Dang, Thailand. Tubercle and Lung Disease, vol. 73, no. 6, pp. 384–387.
[22] Legesse, T., Admenur, G., Gebregzabher, S., et al. (2021). Tuberculosis (TB) in the refugee camps in Ethiopia: trends of case notification, profile, and treatment outcomes, 2014 to 2017. BMC Infectious Diseases, vol. 21, article 139.
[23] Shingadia, D. and Novelli, V. (2003). Diagnosis and treatment of tuberculosis in children. Lancet Infectious Diseases, vol. 3, no. 10, pp. 624–632.
[24] Dogru, S. and Doner, P. (2017). Frequency and outcomes of new patients with pulmonary tuberculosis in Hatay province after Syrian civil war. Indian Journal of Tuberculosis, vol. 64, no. 2, pp. 83–88.
[25] Sukrakanchana-Trikham P, Pue´chal X, Rigal J, Rieder HL. (1992).10-year assessment of treatment outcome among Cambodian refugees with sputum smear-positive tuberculosis in Khao-l-Dang, Thailand. Tuber Lung Dis. vol. 73, no. 6, pp 38–47.
[26] Minetti, A., Camelique, O., Hsa Thaw, K., et al. (2010). Tuberculosis treatment in a refugee and migrant population: 20 years of experience on the Thai-Burmese border. International Journal of Tuberculosis and Lung Disease, vol. 14, no. 12, pp. 1589–1595.
[27] Rutta, E., Kipingili, R., Lukonge, H., et al. (2001). Treatment outcome among Rwandan and Burundian refugees with sputum smear-positivetuberculosis in Ngara, Tanzania. International Journal of Tuberculosis and Lung Disease, vol. 5, no. 7, pp. 628–632.
[28] Boyd, A. T., Cookson, S. T., Almashayek, I., et al. (2019). An evaluation of a tuberculosis case-finding and treatment program among Syrian refugees—Jordan and Lebanon, 2013–2015. BMC Infectious Diseases, vol. 13, article 32.
[29] Ministry of Health (MOH), Sudan. (2018). National TB Management Guideline. MOH, Sudan.
[30] WHO. (2013). Definitions and Reporting Framework for Tuberculosis – 2013 Revision.
[31] Hassanain, S. A., Edwards, J. K., Venables, E., et al. (2018). Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004–2014. Conflict and Health, vol. 12, article 18.
[32] Yang, Z., Kong, Y., Wilson, F., et al. (2004). Identification of risk factors for extrapulmonary tuberculosis. Clinical Infectious Diseases, vol. 38, no. 2, pp. 199–205.
[33] Zhang, X., Andersen, A. B., Lillebaek, T., et al. (2011). Effect of sex, age, and race on the clinical presentation of tuberculosis: a 15-year population-based study. American Journal of Tropical Medicine and Hygiene, vol. 85, no. 2, pp. 285–290.
[34] Manabe, Y. C., Dannenberg, A. M., Jr., Tyagi, S. K., et al. (2003). Different strains of Mycobacterium tuberculosis cause various spectrums of disease in the rabbit model of tuberculosis. Infection and Immunity, vol. 71, no. 10, pp. 6004–6601.
[35] Dogar, O. F., Shah, S. K., Chughtai, A. A., et al. (2012). Gender disparity in tuberculosis cases in eastern and western provinces of Pakistan. BMC Infectious Diseases, vol. 12, article 244.
[36] Severo, N. P., Leite, C. Q., Capela, M. V., et al. (2007). Clinical and demographic characteristics of patients hospitalized with tuberculosis in Brazil between 1994 and 2004. Jornal Brasileiro de Pneumologia, vol. 33, no. 5, pp. 565–571.