Tuberculosis treatment in a refugee and migrant population: 20 years of experience on the Thai-Burmese border
Abstract:SETTING: Although tuberculosis (TB) is a curable disease, it remains a major global health problem and an important cause of morbidity and mortality among vulnerable populations, including refugees and migrants.
OBJECTIVE: To describe results and experiences over 20 years at a TB programme in refugee camps on the Thai-Burmese border in Tak Province, Thailand, and to identify risk factors associated with adverse outcomes (e.g., default, failure, death).
DESIGN: Retrospective review of routine records of 2425 patients admitted for TB treatment in the Mae La TB programme between May 1987 and December 2005.
RESULTS: TB cases notified among refugees decreased over 20 years. Among patients treated with a first-, second- or third-line regimen, 77.5% had a successful outcome, 13.5% defaulted, 7.6% died and 1.3% failed treatment. Multivariate analysis for new cases showed higher likelihood of adverse outcomes for patients who were Burmese migrants or Thai villagers, male, aged >15 years or with smear-negative pulmonary TB.
CONCLUSION: These findings suggest that treatment outcomes depend on the programme's capacity to respond to specific patients' constraints. High-risk groups, such as migrant populations, need a patient-centred approach, and specific, innovative strategies have to be developed based on the needs of the most vulnerable and marginalised populations.
Document Type: Regular Paper
Affiliations: 1: Médecins Sans Frontières, Paris, France 2: Médecins Sans Frontières, Mae Sot, Thailand 3: Department of Community and Social Medicine, Mae Sot General Hospital, Thailand 4: Epicentre, Paris, France
Publication date: 2010-12-01
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