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

Background Severity of TB increases in refugee populations. Monitoring TB case notification and treatment outcomes are essential to improve the effectiveness of TB programs. This study aimed to investigate trends in TB case notification and treatment outcomes and explore factors associated with unsuccessful treatment outcome in refugee camps in Ethiopia. Methods In this retrospective cohort study, demographic and clinical data of all TB cases registered in 25 refugee camps in Ethiopia from January 2014 to December 2017 were extracted. Multivariate logistic regression was fitted to estimate odds ratios and corresponding 95% confidence intervals for the measure of association linked with factors significantly associated with unsuccessful treatment outcomes. Results A total of 1553 TB cases, mean age 27.7 years, were registered from 2014 to 2017. Of these notified cases 54.7% were men, 27.7% children (< 15 years), 71.2% pulmonary TB (PTB), 27.8% Extra-PTB (EPTB) and 98.3% new and relapse. From 2014 to 2017: there was consistent increase in number of notified TB cases (138 to 588 cases), in percentage of EPTB (23.2 to 32.7%), in contribution of children to total TB cases (18.8 to 30.1%) and to EPTB (40.6 to 65.1%), and in proportion of bacteriologically confirmed new and relapse pulmonary cases (43.8 to 64.8%). Treatment success rates for all TB cases remained lower at 72.7-79.4%. On average 24.8% had unfavorable treatment outcome, including 11.5% not evaluated, 8.0% LTFU, 4.8% died and 0.5% treatment failed. Unsuccessful treatment was significantly associated with pretreatment weight below 40 Kg, age over 45 years, and being HIV positive. Conclusions There was continuous increase in notified TB cases and in percentage of childhood TB. Proportion of bacteriologically confirmed new and relapse pulmonary cases increased overtime. TB treatment success remained lower than the national achievement in 2017 (96%) and global target (> = 90%), which needs improvement. The higher LTFU, not evaluated, and death suggests the need to strengthen adherence education and supervision. Special socio-economic support and monitoring is required for patients with pretreatment weight below 40 Kg, age over 45 years and HIV positives.

Automated summary

The study found a continuous increase in tuberculosis cases in refugee camps, with a rising proportion of childhood tuberculosis. Treatment success rates were lower, and unsuccessful treatment outcomes were associated with pretreatment weight, age, and HIV status.