Background
While forced displacement is associated with an increased risk of tuberculosis (TB) transmission, this study sought to assess the results of a contact-tracing (CT) program implemented by the Jordan National Tuberculosis Program (NTP) among Syrian refugees in Jordan.
Objectives
The objectives of this study were to determine: 1. the prevalence of active and latent tuberculosis infection (LTBI) in the contact population; 2. the presence of specific risk factors for LTBI in this population; 3. the ability of this CT program to meet the performance criteria defined by several international guidelines.
Methods
This cross-sectional study included all Syrian refugees diagnosed with pulmonary TB and registered in the Jordan NTP between January 2011 and May 2014 (N=76), as well as their close contacts who underwent medical screening (N=481). In total, 24 variables were extracted from their medical files and recorded for uni- and multivariate descriptive analysis.
Results
Among the contact population, the overall prevalence of LTBI was 24.1% and it reached 26.2% in children aged <5 years. The overall prevalence of active TB was 2.1%, and active TB was twice more frequent in children aged <5 years (5.3%) than in adults (2.5%). The infection risk was significantly higher in contacts of patients whose TB diagnosis was bacteriologically confirmed (OR: 6.33) as well as in the event of previous TB history in the family (OR: 4.94). Having a TB-infected female caregiver also represented a significant risk factor in children aged <15 years (OR: 2.83). The implemented program achieved three of the four efficiency objectives defined by international guidelines.
Discussion
Our results showed that CT programs can be successfully implemented in refugee populations and meet international performance criteria. In line with priorities set by WHO, our findings stress the relevance of screening children and contacts of bacteriologically confirmed cases. Given the specific TB epidemiology among the Syrian refugee population, in addition to the good Jordan NTP infrastructure, the effectiveness of such programs should be further investigated in settings with more limited human and financial resources.
Affiliations
1 Université catholique de Louvain (UCL), Cliniques universitaires Saint-Luc, Pédiatrie générale, B-1200 Burxelles;
2 Fill that Gap
3 National Tuberculosis Program of Jordan