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Tuberculosis and Latent Tuberculosis Infection Among Refugees and Asylum Seekers: A Systematic Review and Meta-Analysis

35 Pages Posted: 22 Oct 2018

See all articles by Raquel Proença

Raquel Proença

affiliation not provided to SSRN

Fernanda M. Souza

affiliation not provided to SSRN

Mayara L. Bastos

affiliation not provided to SSRN

Rosangela Caetano

affiliation not provided to SSRN

José U. Braga

affiliation not provided to SSRN

Eduardo Faerstein

affiliation not provided to SSRN

Anete Trajman

McGill University; Universidade do Estado do Rio de Janeiro (UERJ)

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Abstract

Background: In 2017, there were 68·5 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Tuberculosis prevalence in the country of origin and adverse conditions endured during their journey may increase their risk for tuberculosis. We summarized the prevalence of active and latent tuberculosis infection (LTBI) among refugees and asylum seekers through a literature systematic review and meta-analysis by country of origin.

Methods: Articles published in Medline, EMBASE, Web of Science and LILACS from 2000 to August 2017 were searched for, without language restriction. Two independent reviewers performed all review steps. Random effect models were used to estimate pooled measures of active and latent tuberculosis infection (LTBI) prevalence. Sub-group analyses were performed according to the country of origin and host continent.

Findings: Sixty-seven out of 767 identified papers were included, of which 16 entered the meta-analysis. Pooled prevalence by contry of origin of active and latent tuberculosis were 0·01 [95% confidence interval (CI)=0·00-0·02] and 0·41 (95% CI=0·25-0·57), respectively, both with high level of heterogeneity (I2=98·2% and 99·8%). Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically.

Interpretation: Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention. The high prevalence of active and latent tuberculosis indicates the need for ensuring access to healthcare for early detection, treatment and prevention of the disease, aiming protection of this vulnerable population.

Funding: Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES). RP has had a study grant from the Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES). CAPES is not responsible for any statement in this manuscript.

Declaration of Interests: The authors declare that they have no competing interests.

Ethics Approval Statement: The authors declare: "Not applicable."

Keywords: Refugees, Asylum Seekers, Tuberculosis, Latent Tuberculosis, Prevalence, Global Health, Review, Meta-Analysis

Suggested Citation

Proença, Raquel and Souza, Fernanda M. and Bastos, Mayara L. and Caetano, Rosangela and Braga, José U. and Faerstein, Eduardo and Trajman, Anete, Tuberculosis and Latent Tuberculosis Infection Among Refugees and Asylum Seekers: A Systematic Review and Meta-Analysis (October 17, 2018). Available at SSRN: https://ssrn.com/abstract=3269601 or http://dx.doi.org/10.2139/ssrn.3269601

Raquel Proença

affiliation not provided to SSRN

Fernanda M. Souza

affiliation not provided to SSRN

Mayara L. Bastos

affiliation not provided to SSRN

Rosangela Caetano

affiliation not provided to SSRN

José U. Braga

affiliation not provided to SSRN

Eduardo Faerstein

affiliation not provided to SSRN

Anete Trajman (Contact Author)

McGill University ( email )

1001 Sherbrooke St. W
Montreal, Quebec H3A 1G5
Canada

Universidade do Estado do Rio de Janeiro (UERJ) ( email )

Rua Tonelero, 380 apt. 804
Copacabana, 22030-000
Brazil