High Incidence of Active Tuberculosis in Asylum Seekers from Eritrea and Somalia in the First 5 Years after Arrival in the Netherlands

Boogaard, Jossy van den; Slump, Erika; Schimmel, Henrieke; Hoek, Wim van der; Hof, Susan van den; Vries, Gerard de

doi:10.3201/eid2604.190123

“…(19) Despite worldwide increasing efforts to rapidly implement TB prevention activities among target groups such as high-TB-risk migrants, very few studies have focused on LTBI knowledge, attitudes, beliefs, and stigma. We therefore studied LTBI related knowledge, attitudes, beliefs, and stigma among Eritrean asylum seekers and refugees -currently the largest group of people with TB disease (8,22) in the Netherlands.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

Spruijt¹,

Haile²,

Hof

³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods: We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016-May 2018). We used a thematic analysis to identify, analyse and report patterns in the data.Results: Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. Conclusion: The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

show abstract

“…(5) More particularly, TB burden in the Netherlands is currently highest among Eritrean asylum seekers and refugees with TB incidence rates of 925/100,000 person-years in the rst year and 309/100,000 person-years in the fth year post arrival. (6) To reduce the individual TB burden and the country's incidence, LTBI screening and treatment is being implemented in the Netherlands among immigrants 18 years and younger. Following the need to increase efforts to reduce the TB incidence and the positive results of three implementation studies (7)(8)(9), Dutch policy advisors are now debating about expanding the implementation of post-arrival LTBI screening to other subgroups of immigrants and asylum seekers.…”

Section: Introductionmentioning

confidence: 99%

“…(17) Despite worldwide increasing efforts to rapidly implement TB prevention activities among target groups such as high-TB-risk migrants, very few studies have focused on LTBI knowledge, attitudes, beliefs, and stigma. We therefore studied LTBI related knowledge, attitudes, beliefs, and stigma among Eritrean asylum seekers and refugees -currently the largest group of people with TB disease (6,20) in the Netherlands.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

Spruijt¹,

Haile²,

Hof

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods: We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016-May 2018). We used a thematic analysis to identify, analyse and report patterns in the data.Results: Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. Conclusion: The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

show abstract

“…(7) More particularly, TB burden in the Netherlands is currently highest among Eritrean asylum seekers and refugees with TB incidence rates of 925/100,000 person-years in the rst year and 309/100,000 personyears in the fth year post arrival. (8) Following the need to increase efforts to reduce the TB incidence and the positive results of three implementation studies on LTBI screening and treatment among high TB risk migrants groups (9)(10)(11), Dutch policy advisors are now debating about expanding the implementation of post-arrival LTBI screening to other subgroups of immigrants and asylum seekers. (4) Stigma can hamper the effectiveness of LTBI screening and treatment programs as it may impede the uptake of testing and treatment because of people's concern about reputational loss and stigma by participating in a "TB project".…”

Section: Introductionmentioning

confidence: 99%

“…We therefore studied LTBI related knowledge, attitudes, beliefs, and stigma among Eritrean asylum seekers and refugees -currently the largest group of people with TB disease in the Netherlands. (8,22) Methods This qualitative study was part of the TB-ENDPoint project, which studied the implementation, national impact, and cost effectiveness of LTBI screening and treatment among high-TB-risk migrant groups in the Netherlands. This project incorporated three mixed method studies (qualitative and quantitative research methods), which evaluated the implementation of LTBI screening and treatment among 1) immigrants (9), 2) asylum seekers -predominantly Eritreans-living in asylum seeker centres (11), and 3) Eritrean refugees living in communities for maximum ten years.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

Spruijt¹,

Haile²,

Hof

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs, and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods: We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016-May 2018). We used a thematic analysis to identify, analyse and report patterns in the data.Results: Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment.Conclusion: The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

show abstract

High Incidence of Active Tuberculosis in Asylum Seekers from Eritrea and Somalia in the First 5 Years after Arrival in the Netherlands

Cited by 16 publications

References 16 publications

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

Contact Info

Product

Resources

About