Armed conflict and human displacement may lead to an increase in the burden of tuberculosis in Europe

Impacts of armed conflicts on tuberculosis burden and treatment outcomes: a systematic review

OBJECTIVES

This systematic review aimed to summarise existing literature on the impacts of armed conflicts on tuberculosis burden and treatment outcomes.

DESIGN

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, ScienceDirect, Embase and medRxiv.

DATA EXTRACTION AND SYNTHESIS

Three reviewers independently screened, selected eligible studies and extracted data. A narrative review was undertaken to summarise the findings qualitatively.

RESULTS

Eleven studies were included in this review, reporting on tuberculosis incidence rates, prevalence and treatment outcomes, including mortality. Overall, the impact of armed conflicts on case notifications was variable. Six studies reported overall increases in tuberculosis case notifications following the onset of conflicts, while three studies reported overall decreases in tuberculosis case notifications. Factors, including limited access to healthcare services, challenges in surveillance and laboratory confirmation, the destruction of health systems and incapacitating the healthcare workforce, contributed to a decrease in the number of notified cases. The higher tuberculosis notification in some of the studies could be attributed to the disruption of tuberculosis prevention and control programmes as well as increased socioeconomic deprivation, including malnutrition, mass migration, poor living conditions and overcrowding that are worsened during conflicts. Armed conflicts without effective interventions were associated with worse tuberculosis treatment outcomes, including lower proportions of people with treatment success and higher proportions of people with loss to follow-up, mortality and treatment failure. However, implementing various interventions in conflict settings (such as establishing a National Tuberculosis Control Programme) led to higher tuberculosis notification rates and treatment success.

CONCLUSION

The impact of armed conflicts on tuberculosis notification is complex and is influenced by multiple factors. The findings of this review underscore the importance of concerted efforts to control tuberculosis in conflict settings using available resources.

Treatment outcomes and risk factors for an unsuccessful outcome among patients with highly drug-resistant tuberculosis in Ukraine

OBJECTIVES

To describe demographics, clinical features, and treatment outcomes of patients with highly drug-resistant tuberculosis (TB) in Ukraine, and to evaluate risk factors for an unsuccessful outcome.

METHODS

Data from patients with multi-, pre-extensively, or extensively drug-resistant TB were collected prospectively from TB dispensaries in 15 out of 24 Ukrainian oblasts (regions) from 2020 to 2021. Treatment outcomes were evaluated using WHO definitions. Risk factors for an unsuccessful outcome were identified using a multivariable logistic regression model.

RESULTS

Among 1748 patients, the overall proportion of successful outcomes was 58% (95% confidence interval [95% CI] 56-60) (n = 1015/1748), ranging from 65% (95% CI: 62-69) (n = 531/814) for multidrug-resistant TB to 54% (95% CI: 49-58) (n = 301/563) for pre-extensively drug-resistant TB and 49% (95% CI: 44-55) (n = 183/371) for extensively drug-resistant TB. Results were similar across oblasts, with few exceptions. The strongest risk factors for an unsuccessful outcome were extensively drug-resistant TB (adjusted OR [aOR] 3.23; 95% CI: 1.88-5.53), total serum protein below 62 g/L in adults and below 57 g/L for children and adolescents (aOR 2.79; 95% CI: 1.93-4.04), psychiatric illness (aOR 2.79; 95% CI: 1.46-5.33), age at TB diagnosis >65 years (aOR 2.50; 95% CI: 1.42-4.42), and alcohol misuse (aOR 2.48; 95% CI: 1.89-3.26).

DISCUSSION

The overall proportion of successful outcomes among Ukrainians treated for highly drug-resistant TB was 58%, notably better compared with previous years, but still low for extensively drug-resistant TB. Risk factors for unsuccessful outcomes highlight that addressing socioeconomic factors in TB management is crucial. Efforts in maintaining TB dispensaries during and following the ongoing war are highly warranted.

The Impact of the War in Ukraine on the Epidemiological Situation of Tuberculosis in Europe

Ukraine is at the forefront of one of the largest outbreaks of tuberculosis (TB) in Europe, including multidrug-resistant tuberculosis. Due to the ongoing armed conflict in this area, there is a significant number of refugees from Ukraine to other European countries. The aim of the study is to emphasize the essence of the problem of the increased incidence of tuberculosis, taking into account the impact of the armed conflict in Ukraine, resulting in the intensification of migration movements. A descriptive epidemiological method was used as the research method. The material was collected by analyzing source statistical data from WHO and statistical yearbooks of selected European countries. Particularly, Ukrainian refugees in Poland, Germany, the Czech Republic, and Slovakia are at higher risk of contracting tuberculosis due to factors like migration stress, poor nutrition, and comorbidities. Epidemiological data from these countries show a rise in tuberculosis cases among foreigners, emphasizing the need for European specialists to be more vigilant in this unique situation, focusing on refugees and other vulnerable populations. More research and collaborative efforts are essential to closely monitor and prevent the severe outcomes of tuberculosis transmission.

Uniting for Ukraine Tuberculosis Screening Experience, San Francisco, California, USA

Ukraine surveillance data suggest high tuberculosis (TB) incidence, including multidrug resistance. Of 299 newcomers from Ukraine screened in San Francisco, California, USA, by using an interferon-γ-release-assay (IGRA) and chest radiograph, 7.4% were IGRA positive and 1 had laboratory-confirmed pansusceptible TB. Screening with IGRA and chest radiograph can help characterize TB risk.

The outbreak of the 2022 Russo-Ukrainian war: mental health of poles and their attitude to refugees

Introduction

The outbreak of the Russo-Ukrainian war on 24 February 2022 has sparked a migration crisis in Europe. As a result, Poland has emerged as the country with the highest number of refugees. Due to differing social and political sentiments, this has been a significant challenge for the hitherto mono-ethnic Polish society.

Methods

Computer-assisted web interviews (CAWIs) were conducted with 505 Poles, mainly women with higher education from large urban centers, involved in helping refugees. Their attitudes toward refugees were assessed using an original questionnaire, while their mental health was also evaluated using the General Health Questionnaire-28 (GHQ-28).

Results

The vast majority of respondents reported favorable attitudes toward refugees from Ukraine. In addition, 79.2% believed refugees should be given free access to medical care, and 85% supported free access to education for migrants. Nearly 60% of respondents were not worried about their financial status due to the crisis; moreover, 40% believed that immigrants could boost the Polish economy. And 64% believed it would enrich Poland culturally. However, the majority of respondents feared infectious diseases and believed migrants should be vaccinated according to the vaccination schedule applicable in the country. Fear of war correlated positively with fear of refugees. On the GHQ-28, almost half of the respondents scored above clinical significance. Higher scores were typical for women and those fearing war and refugees.

Conclusion

Polish society has shown a tolerant attitude in the face of the migration crisis. The vast majority of respondents showed positive attitudes toward refugees from Ukraine. The ongoing war in Ukraine has a negative impact on the mental health of Poles, which correlates with their attitude toward refugees.