Active and latent tuberculosis in refugees and asylum seekers: a systematic review and meta-analysis

Abstract

Background: In 2018, there were 70.8 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Many of these individuals face a high risk for tuberculosis in their country of origin, which may be accentuated by adverse conditions endured during their journey. Objective: We summarised the prevalence of active and latent tuberculosis infection in refugees and asylum seekers through a systematic literature review and meta-analyses by country of origin and host continent. Methods: Articles published in Medline, EMBASE, Web of Science and LILACS from January 2000 to August 2017 were searched for, without language restriction. Two independent authors performed the study selection, data extraction and quality assessment. Random effect models were used to estimate average measures of active and latent tuberculosis prevalence. Sub-group meta-analyses were performed according to country of origin and host continent. Results: Sixty-seven out of 767 identified articles were included, of which 16 entered the meta-analyses. Average prevalence of active and latent tuberculosis was 1331 per 100 thousand inhabitants [95% confidence interval (CI) = 542-2384] and 37% (95% CI = 23-52%), respectively, both with high level of heterogeneity (variation in estimative attributable to heterogeneity [I 2 ] = 98.2% and 99.8%). Prevalence varied more according to countries of origin than host continent. Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Many studies failed to provide relevant information. Conclusion: Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention in any host continent. To protect this vulnerable population, ensuring access to healthcare for early detection for prevention and treatment of the disease is essential.

Trends of Tuberculosis Treatment Outcomes of Notified Cases in Three Refugee Camps in Sudan: A Four-year Retrospective Analysis, 2014–2017

“…Majority (>86%) of refugees are from and stay within developing countries where the TB burden is higher [12]. Studies have shown an increase in the prevalence of TB [13,14] and TB case notification [14,15] when the number of refugee population increases. Thus, key populations such as refugees have been given special focus in the Stop TB [16] and End TB [2] WHO strategic documents so as to achieve the global targets by 2035.…”

“…The aforementioned pieces of evidence [13][14][15][16][17] indicate that TB is one of the main health problems in the refugee camps of Sudan. Hence, periodic review of TB program performance in the refugee camps is needed to address the gaps and improve the implementation of TB care and prevention program.…”

Tuberculosis (TB) in the refugee camps in Ethiopia: Trends of case notification, profile, and treatment outcomes, 2014 to 2017

“…The total end year refugee population in Ethiopia was continuously increased from 491030 in 2014 to 728000 by 2017. The highest refugee population by 2017 were in Gambella refugee area (219,708), followed by Dollo Ado (197.952), Shire (109, 360), Asossa (55.726), Jijiga (35,024), Afar (15.390), and Mizan (11,761) [15].…”

“…Usually, majority (> 85%) of refugees originate from and remain within countries with high burdens of TB [10]. However, according to a recent systemic review and meta-analysis, TB prevalence in refugees and asylum seekers varied more according to countries of origin than the host continent [11]. Other also reported, an association between immigration and increased prevalence of either TB or EPTB [12].…”

Analysis of Tuberculosis Cases Notification and Treatment Outcomes Among Refugee Camps In Kenya: Four Year Retrospective Study, 2014-2017

“…Usually, majority (> 85%) of refugees originate from and remain within countries with high burdens of TB [10]. A recent systemic review and meta-analysis showed that TB prevalence in refugees and asylum seekers varied more according to countries of origin than the host country [11], whereas others reported association between continuous immigration (increase in migrant population) and increase in prevalence of PTB and EPTB [12], in TB case noti cation [13] and in case detection rate [14].…”