The ongoing challenge of Pulmonary Tuberculosis in Southern Tunisia: a review of a 22-year period - 11/02/20

Doi : 10.1016/j.resmer.2020.02.002

Maissa Ben Jmaa ^1,^⁎ , Houda Ben Ayed ^4,⁶, Makram Koubaa ^2,⁴, Fatma Hammemi ^2,⁴, Maroua Trigui ¹, Mariem Ben Hmida ¹, Neila Zalila ³, Chakib Marrakchi ^2,⁴, Sourour Yaich ¹, Sami Kammoun ⁵, Jamel Damak ¹, Mounir Ben Jemaa ^2,⁴
¹ Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
² Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
³ Regional Primary Health Care Directory, Sfax, Tunisia
⁴ Extra-pulmonary Research Unity, Hedi Chaker University Hospital, Sfax, Tunisia
⁵ Department of Pneumology, Hedi Chaker University Hospital, Sfax, Tunisia
⁶ Department of Preventive Medicine and Hospital Hygiene, Hedi Chaker University Hospital, Sfax, Tunisia

^⁎Corresponding author. Telephone number:+216 53033594.Telephone number:+216 53033594.

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Abstract

Background

Despite the wide use of anti-tuberculosis drugs, pulmonary tuberculosis (PTB) remains one of the most important causes of mortality and morbidity, particularly in developing countries. Therefore, combining clinical and epidemiological approach would be of a great benefit.Our study aimed to describe the epidemiological and clinical specificities of PTB and its recent chronological trends.

Methods

We conducted a retrospective study of all PTB new cases of any age diagnosed between 1995 and 2016 in Southern Tunisia.We applied the direct method of age-standardization using the World Standard Population to compute the age standardized incidence rate (ASIR) and the age standardized mortality rate (ASMR) per 100000 inhabitants.

Results

We recorded 1121 new cases with PTB among 2771 new cases of tuberculosis (40.5%). The ASIR of PTB was 5.3/100000 inhabitants/year and didn’t change over the study period (rho=1/20.3;p=0.2). Patients with PTB were mainly aged between 15 and 59 years (n=861;76.8%) and came from urban areas (n=600;55%). The median duration of treatment was 7.6 months (IQR=[6-8 months]). Successful outcome was notified in 1075 cases (95.9%). Forty-one patients died yielding an ASMR of 0.18/100000 inhabitants/year. Factors statistically associated with unsuccessful outcome included age =60 years (OR=5; p=0.001) and shorter treatment duration (6.15 months vs 7.76 months; p=0.001).

Conclusion

In contrast to the decline in the global PTB incidence reported worldwide and in the neighboring countries, our study revealed no significant change in the PTB rates from 1995 to 2016. Therefore, tools and strategies used to manage PTB should be strengthened by a substantial effort in both basic science and epidemiology to have better incidence curves.

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Keywords : Outcome, Pulmonary, Trends, Tuberculosis