Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014
| dc.contributor.author | Hassanain, Sara A | |
| dc.contributor.author | Edwards, Jeffrey K | |
| dc.contributor.author | Venables, Emilie | |
| dc.contributor.author | Ali, Engy | |
| dc.contributor.author | Adam, Khadiga | |
| dc.contributor.author | Hussien, Hafiz | |
| dc.contributor.author | Elsony, Asma | |
| dc.date.accessioned | 2018-05-21T07:10:53Z | |
| dc.date.available | 2018-05-21T07:10:53Z | |
| dc.date.issued | 2018-05-16 | |
| dc.date.updated | 2018-05-20T03:39:16Z | |
| dc.description.abstract | Background Sudan is a fragile developing country, with a low expenditure on health. It has been subjected to ongoing conflicts ever since 1956, with the Darfur crisis peaking in 2004. The conflict, in combination with the weak infrastructure, can lead to poor access to healthcare. Hence, this can cause an increased risk of infection, greater morbidity and mortality from tuberculosis (TB), especially amongst the poor, displaced and refugee populations. This study will be the first to describe TB case notifications, characteristics and outcomes over a ten-year period in Darfur in comparison with the non-conflict Eastern zones within Sudan. Methods A cross-sectional review of the National Tuberculosis Programme (NTP) data from 2004 to 2014 comparing the Darfur conflict zone with the non-conflict eastern zone. Results New case notifications were 52% lower in the conflict zone (21,131) compared to the non-conflict zone (43,826). Smear-positive pulmonary TB (PTB) in the conflict zone constituted 63% of all notified cases, compared to the non-conflict zone of 32% (p < 0.001). Extrapulmonary TB (EPTB) predominated the TB notified cases in the non-conflict zone, comprising 35% of the new cases versus 9% in the conflict zone (p < 0.001). The loss to follow up (LTFU) was high in both zones (7% conflict vs 10% non-conflict, p < 0.001) with a higher rate among re-treatment cases (12%) in the conflict zone. Average treatment success rates of smear-positive pulmonary TB (PTB), over ten years, were low (65-66%) in both zones. TB mortality among re-treatment cases was higher in the conflict zone (8%) compared to the non-conflict zone (6%) (p < 0.001). Conclusion A low TB case notification was found in the conflict zone from 2004 to 2014. High loss to follow up and falling treatment success rates were found in both conflict and non-conflict zones, which represents a significant public health risk. Further analysis of the TB response and surveillance system in both zones is needed to confirm the factors associated with the poor outcomes. Using context-sensitive measures and simplified pathways with an emphasis on displaced persons may increase access and case notification in conflict zones, which can help avoid a loss to follow up in both zones. | |
| dc.identifier.apacitation | Hassanain, S. A., Edwards, J. K., Venables, E., Ali, E., Adam, K., Hussien, H., & Elsony, A. (2018). Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014. <i>Conflict and Health</i>, http://hdl.handle.net/11427/28102 | en_ZA |
| dc.identifier.chicagocitation | Hassanain, Sara A, Jeffrey K Edwards, Emilie Venables, Engy Ali, Khadiga Adam, Hafiz Hussien, and Asma Elsony "Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014." <i>Conflict and Health</i> (2018) http://hdl.handle.net/11427/28102 | en_ZA |
| dc.identifier.citation | Conflict and Health. 2018 May 16;12(1):18 | |
| dc.identifier.ris | TY - Journal Article AU - Hassanain, Sara A AU - Edwards, Jeffrey K AU - Venables, Emilie AU - Ali, Engy AU - Adam, Khadiga AU - Hussien, Hafiz AU - Elsony, Asma AB - Background Sudan is a fragile developing country, with a low expenditure on health. It has been subjected to ongoing conflicts ever since 1956, with the Darfur crisis peaking in 2004. The conflict, in combination with the weak infrastructure, can lead to poor access to healthcare. Hence, this can cause an increased risk of infection, greater morbidity and mortality from tuberculosis (TB), especially amongst the poor, displaced and refugee populations. This study will be the first to describe TB case notifications, characteristics and outcomes over a ten-year period in Darfur in comparison with the non-conflict Eastern zones within Sudan. Methods A cross-sectional review of the National Tuberculosis Programme (NTP) data from 2004 to 2014 comparing the Darfur conflict zone with the non-conflict eastern zone. Results New case notifications were 52% lower in the conflict zone (21,131) compared to the non-conflict zone (43,826). Smear-positive pulmonary TB (PTB) in the conflict zone constituted 63% of all notified cases, compared to the non-conflict zone of 32% (p < 0.001). Extrapulmonary TB (EPTB) predominated the TB notified cases in the non-conflict zone, comprising 35% of the new cases versus 9% in the conflict zone (p < 0.001). The loss to follow up (LTFU) was high in both zones (7% conflict vs 10% non-conflict, p < 0.001) with a higher rate among re-treatment cases (12%) in the conflict zone. Average treatment success rates of smear-positive pulmonary TB (PTB), over ten years, were low (65-66%) in both zones. TB mortality among re-treatment cases was higher in the conflict zone (8%) compared to the non-conflict zone (6%) (p < 0.001). Conclusion A low TB case notification was found in the conflict zone from 2004 to 2014. High loss to follow up and falling treatment success rates were found in both conflict and non-conflict zones, which represents a significant public health risk. Further analysis of the TB response and surveillance system in both zones is needed to confirm the factors associated with the poor outcomes. Using context-sensitive measures and simplified pathways with an emphasis on displaced persons may increase access and case notification in conflict zones, which can help avoid a loss to follow up in both zones. DA - 2018-05-16 DB - OpenUCT DP - University of Cape Town J1 - Conflict and Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014 TI - Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014 UR - http://hdl.handle.net/11427/28102 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s13031-018-0154-0 | |
| dc.identifier.uri | http://hdl.handle.net/11427/28102 | |
| dc.identifier.vancouvercitation | Hassanain SA, Edwards JK, Venables E, Ali E, Adam K, Hussien H, et al. Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014. Conflict and Health. 2018; http://hdl.handle.net/11427/28102. | en_ZA |
| dc.language.iso | en | |
| dc.publisher | BioMed Central | |
| dc.publisher.department | Department of Public Health and Family Medicine | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.rights.holder | The Author(s). | |
| dc.source | Conflict and Health | |
| dc.source.uri | https://conflictandhealth.biomedcentral.com/ | |
| dc.subject.other | Sudan | |
| dc.subject.other | Conflict | |
| dc.subject.other | Non-conflict | |
| dc.subject.other | Tuberculosis programme | |
| dc.subject.other | Performance | |
| dc.subject.other | Darfur | |
| dc.subject.other | Outcomes | |
| dc.subject.other | Operational research | |
| dc.title | Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014 | |
| dc.type | Journal Article | |
| uct.type.filetype | Text | |
| uct.type.filetype | Image |