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[Tuberculosis control in refugees and displaced persons] El control de la tuberculosis en refugiados y desplazados.
Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 1997 Oct; 2(4):295-8.This article explains why tuberculosis (TB) control among refugees is of utmost importance and details World Health Organization recommendations for implementation of TB control programs among refugees. Nearly 3 million TB deaths occur each year, 98% in developing countries. Although most of the estimated 27 million refugees in 1995 lived in endemic TB zones, few efforts have been made to prevent TB spread among refugees or treat cases. The mobility of refugees and uncertainty about the length of their stay in refugee camps, and the need to control measles, malnutrition, and diarrheal diseases in the initial phases of refugee encampment, weaken the priority given to TB. However, once the initial problems of establishing a camp are overcome, TB becomes the principal health issue. In recent years, some TB treatment programs in refugee camps have achieved cure rates comparable to those of national programs. A TB control program should not be established in a refugee camp until the initial emergency phase is over and stability and safety can be assured for a minimum of 6 months. Statistics should be available confirming that TB is a problem in the camp, and the control program should be coordinated with the national program so that patients can continue to receive treatment if the camp closes. The priorities for TB control in refugees are 1) passive case detection, 2) assignment of priority to cases diagnosed through examination of sputum, 3) provision of short-term therapy under direct supervision, 4) commitment of the authorities and effective leadership, 5) establishment of a monitoring system for quality supervision and evaluation, and 6) BCG vaccination of small children in countries with high TB prevalence. The national TB program of the host country should be given quarterly reports on case detection and treatment in the refugee camp. A cohort system should be used for calculating cure rates to permit program monitoring.