Tuberculosis (TB) remains a significant global public health issue, ranking as the second leading cause of mortality after the human immunodeficiency virus (HIV). In 2013, there were an estimated 9 million new cases and 1.5 million associated deaths.1 A substantial proportion of the world’s population is also affected by humanitarian crises each year, resulting in high numbers of both internally displaced persons (IDPs) and refugees.2 By the end of 2013 there were approximately 51.2 million people forcibly displaced (including 33.3 million IDPs), 6 million more than in the previous year.3 Despite a decline in worldwide TB prevalence over the last decade – largely attributed to effective diagnosis and treatment interventions – TB-associated…show more content… While the majority of TB cases and associated mortality occur among males, women and children also bare a high burden, accounting for more than 30% and 6% of new cases and deaths, respectively.1
In 2013, about 3.5% of new cases and 20.5% of previously-treated cases were multi-drug resistant (MDR) (see Table 1), of which 9.0% were extensively drug resistant (XDR), a proportion that has not changed over several years.1 Moreover, of the 9 million people who developed TB in 2013, more than 1.1 million (13%) were also HIV-positive, with the African region accounting for nearly four out of every five HIV-positive TB cases and deaths among HIV-positive people1 (see Figure 1).
The majority of new TB cases tend to occur in the South-East Asian and Western Pacific regions (56%), and a further one quarter cases are found in the African regions (25%) (see Figure 2), for which the highest rates of cases and deaths relative to population were documented in 20131 (see Table 2). It is in these countries specifically that issues of resistance and poor treatment outcomes are of most concern, particularly their effect on vulnerable populations like IDPs and refugees.
B. Among Emergency-Affected Populations