Prevalence of tuberculosis and associated factors among presumptive TB refugees residing in refugee camps in Ethiopia

Meaza et al. BMC Infectious Diseases (2023) 23:498 https://doi.org/10.1186/s12879-023-08469-5 BMC Infectious Diseases Open Access RESEARCH Prevalence of tuberculosis and associated factors among presumptive TB refugees residing in refugee camps in Ethiopia Abyot Meaza1,2*, Bazezew Yenew2, Miskir Amare2, Ayinalem Alemu1,2, Michael Hailu2, Dinka Fikadu Gamtesa2, Mirgissa Kaba3, Girmay Medhin1, Gobena Ameni1,4 and Balako Gumi1 Abstract Background Tuberculosis (TB) causes significant morbidity and mortality in refugee populations. Although Ethiopia is the third largest refugee-hosting country in Africa, there is limited published data on the prevalence and associated factors of TB in refugees. The objective of this study was to estimate the prevalence of bacteriologically confirmed pulmonary TB (PTB) and explore associated factors in presumptive TB refugees residing in refugee camps in Ethiopia. Methods A facility-based cross-sectional study was conducted between February and August 2021 in refugee camps in Ethiopia. Data were collected consecutively from 610 presumptive TB refugees who attended for TB diagnosis in selected refugee camp clinics in Ethiopia. A pre-tested questionnaire was used to collect data, and sputum samples were collected from eligible study participants. The Xpert Mycobacterium tuberculosis (MTB)/Rifampicin (RIF) assay was performed on direct spot sputum samples, whereas morning sputum samples were processed and inoculated for bacteriological culture using Mycobacterium Growth Indicator Tube (MGIT) and Lowsteen Jensen (LJ) methods. The statistical software package (STATA version 14) was used for statistical analysis. A logistic regression model was used for the evaluation of the association between bacteriologically confirmed TB cases and the associated factors. Descriptive statistics were used for the expression of the results, and statistical significance was assumed at p < 0.05. Results Out of 610 study participants, more than half were female (54.9%), and the mean age was 37.9 years (SD, 16.64). The prevalence of bacteriologically confirmed PTB cases among refugees residing in refugee camps in Ethiopia was 13.3% (95% CI, 10.7–16.2%) using the Xpert MTB/RIF assay and/or culture. MTB was detected in 12.8% (95% CI, 10.2–15.7%) of the individuals using the Xpert MTB/RIF assay, while culture positivity was observed in 11.6% (95% CI, 9.2–14.5%). The multivariable logistic regression model showed South Sudan origins (adjusted odds ratio, AOR = 7.74; 95% CI, 3.05–19.64), age group, 19–38 years old (AOR = 5.66; 95% CI, 1.86–17.28), and male sex (AOR = 2.69; 95% CI, 1.58–4.56) were significantly associated with the bacteriologically confirmed TB among refugees residing in refugee camps in Ethiopia. Conclusion The prevalence of bacteriologically confirmed PTB among presumptive TB refugees residing in refugee camps in Ethiopia was high. The national TB program should strengthen TB prevention and control activities in the *Correspondence: Abyot Meaza Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Meaza et al. BMC Infectious Diseases (2023) 23:498 Page 2 of 9 refugee camps of Ethiopia. Moreover, an active TB survey program should be implemented in refugee camps in Ethiopia. Keywords Prevalence, Tuberculosis, Presumptive, Refugees, Refugee camps in Ethiopia Introduction Tuberculosis (TB) is a major public health problem throughout the world, infecting an estimated quarter of the world’s population and putting them at risk of developing active disease during their lifetime [1]. TB is a communicable disease that causes ill health and it is one of the leading causes of death worldwide [1]. The recent World Health Organization (WHO) report indicated 10.6 million new cases and 1.6 million deaths occurred in 2021 globally [1], while 2.5 million new cases and more than a half million deaths were reported from the WHO African region [1]. There are existing guidelines and strategies for TB diagnosis [2], treatment [3], prevention, and control [4, 5] to combat the TB epidemic. Ethiopia remains among the global high TB burden countries, with an annual TB incidence of 119 cases per 100,000 population in 2021 [6]. Detection of TB cases and linkage to TB treatment are the key intervention areas of the TB prevention and control program in Ethiopia [6]. TB is an important cause of morbidity and mortality among refugees [7]. Conflict is the most common cause of displacement of a large population, which often results in relocation to temporary settlements (e.g., camps) with a significant risk of exposing people to becoming refugees [7]. Refugees refer to people who are outside their country and cannot return owing to a well-founded fear of persecution because of their race, religion, nationality, political opinion, or membership in a particular social group [8]. Factors including malnutrition and overcrowding in camp settings increase the vulnerability of displaced populations [7]. TB is one of the infectious diseases that can affect refugees due to poor living conditions and overcrowding [9]. Consequently, the incidence and prevalence of TB among refugees and migrant populations are higher than among non-refugee populations [10]. In a recent systematic review, the incidence and prevalence of TB ranged from 19 to 754 cases per 100,000 population and 18.7 to 535 cases per 100,000 population, respectively [10]. The arrival of large groups of refugees into a given country can affect TB control in receiving countries by significantly increasing the disease burden and cost of health services. Moreover, migrant and refugee communities have special health needs and experience obstacles to accessing health care [9]. The number of refugees exceeded 100 million in 2022, which was the highest level that the UNHCR has seen in its almost 75 years [11]. Sub-Saharan Africa hosted more than 26% o (...truncated)