Human Mobility & Tuberculosis
5 things to know about migrants and TB
As the world joins forces to combat the new coronavirus disease (COVID-19) pandemic, we must not forget about the world’s number 1 infectious killer, tuberculosis (TB), and its devastating health, social and economic consequences on the world’s most vulnerable.
According to the World Health Organization (WHO), each day, over 4,000 people die from TB and close to 30,000 people contract this preventable and curable disease.
These are five things you should know:
1. TB disproportionately affects poor and marginalized populations
Poor living conditions are a risk factor for TB. Maiduguri, Nigeria, 2018. IOM/M. Mohammed.
The sub-standard conditions in which some migrants may be forced to travel, live and work, can increase their vulnerability or exposure to TB. Migrants, regardless of their legal status, may face food insecurity and malnutrition, or end up facing systemic barriers to accessing health care. Other vulnerable populations may be detained in over-crowded facilities or live in camps as refugees or internally displaced persons, with no or inadequate access to TB medicine, which can lead to the development of drug-resistant forms of TB.
All of the above are major risk factors for TB, and therefore, the realization of true Universal Health Coverage, one that leaves no migrant behind, is critical in ensuring that TB is eradicated for everyone one day.
2. Stigma and discrimination remain major obstacles in tackling TB worldwide
IOM’s mobile health teams offer hygiene promotion sessions. Yangon, Myanmar, 2016. IOM/M. Mohammed
Because important public health messaging often fails to reach the most vulnerable people in a society, TB health literacy is relatively low among migrants and refugees: migrants with pulmonary and extra-pulmonary TB may be unaware of the signs and symptoms, which makes them less likely to seek treatment, or know how to protect their loved ones from catching it. Those who are informed and have identified their symptoms — persistent cough, night sweats and weight loss — may be reluctant to provide this medical history to health workers, for fear of stigmatization or losing the opportunity to be resettled.
In order to adequately tackle this global challenge, it is critical that migrants and refugees be informed in their own languages of the risks of TB, and that they feel safe enough to seek help, without fear of stigmatization, arrest or deportation.
3. TB detection and management services are provided for refugees and migrants at the request of receiving country governments
A migrant starts his health assessment process at one of IOM’s centres. Nairobi, Kenya, 2020. IOM/Y. Guerda
In the migration context, tuberculosis detection and control continue to be an important public health concern for both countries of origin and destination, as well as migrants and their families. IOM contributes to cross-border tuberculosis detection and control by providing a wide variety of tuberculosis-related services, from diagnostics to treatment, as well as public health measures, such as contact tracing and health education. These services are provided through more than 65 IOM Migration Health Assessment Centres (MHAC) worldwide, most of which are located in countries with an intermediate or high burden of TB.
4. In 2019, IOM diagnosed some 600 people with TB through its pre-migration health activities
An Iraqi refugee in Jordan shows his X-ray from his TB screening. Jordan, 2018. The Global Fund/V. Becker
Worldwide, in 2019, IOM conducted approximately 428,000 migration health assessments for migrants and refugees and detected 590 active cases of TB, or 138 cases per 100,000 migration health assessments (data as of March 2020). Active TB cases were either confirmed by sputum culture or diagnosed based on clinical and radiological findings. In 2019, 16 IOM laboratories provided TB diagnostic services and approximately 13,000 microbiological tests were performed Treatment for active TB cases detected by IOM health assessment programmes is provided either directly by IOM or via a referral system, in partnership with national TB programmes (NTPs).
5. Every year, IOM accompanies hundreds of migrants through their treatment
An IOM nurse and her translator DeeDee provide DOT for a TB patient at an IOM health post. Mae Lat camp, Thailand, 2012. IOM
TB treatment requires discipline and perseverance: in the best of cases, the patient has to take only one pill every day for six months; in the worst case, the treatment involves a cocktail of pills that are preferably taken on an empty stomach, every single day, six to 12 months. Nausea, dizziness, pains, fatigue… the side effects can be extremely heavy and adhering to the requirements is often challenging, especially without a solid social support system or due to mental health issues.
Directly observed treatment (DOT) is the internationally recommended strategy for TB control and is used by IOM’s MHACs wherever possible to increase patients’ adherence to and completion of TB treatment. At IOM’s MHAC in Nairobi, Kenya, for example, IOM’s TB DOT success rate stands at 96%.
Tuberculosis is preventable. Tuberculosis is treatable. It’s time to put an end to it by including migrants in our efforts to tackle it.
Tuberculosis is one of the world’s main health challenges with 9 million new cases and nearly 1.5 million deaths each year. Approximately one third of new cases are missed by the health system and occur in populations which are most vulnerable to TB including migrants, Internally Displaced Persons (IDPs), refugees and other crisis-affected individuals due to poor nutrition status, poor living and working conditions, low education and awareness, and low health-care access.
Emergencies such as natural disasters, conflict-related humanitarian crises and migration crises result in disruption of the capacity of public health systems to meet the health care needs of affected populations. Forced displacement often results in relocation to camps or other temporary settlements where risk factors such as overcrowding, malnutrition, substance abuse, social exclusion, disruption of regular health care and poor health seeking behavior make affected populations more vulnerable to TB. Additionally, emergency health responses traditionally focus on acute disease threats such as measles and cholera outbreaks leaving chronic conditions such as TB unattended until too late.
The collapse of health systems in emergencies decreases access to TB awareness, prevention and continuity of care at points of origin, transit and travel, at destination and upon return within and across borders.
It is critical to address concerns of limited identification of TB cases, inadequate TB provision services, interruption of drug supply, irregular drug intake, increase in treatment defaulting, low cure rate, higher number of patients with relapse and an increase in Multidrug-resistant (MDR) TB among others.
IOM’s TB in emergencies programme is based on extensive experience with TB prevention, diagnostic and treatment services under its Migration Health Assessments and Travel Health Assistance programme for immigration and refugee resettlement and TB REACH programmes worldwide. Guided by the 2014 WHO End TB Strategy, IOM supports National TB Programmes (NTPs) under the Ministry of Health in non-crisis and crisis situations. Activities are coordinated and consistent with national protocols and regulations to ensure accountability to nation health authorities.
IOM provides a comprehensive range of TB screening related services, including physical examinations, radiological investigation, tuberculin skin test, sputum smear and culture, drug susceptibility testing (DST) and directly observed treatment (DOT). TB treatment is provided either directly by IOM or through a referral system, in partnership with National TB Programmes (NTPs).
IOM TB activities in emergencies aim to reduce avoidable morbidity and mortality through awareness, preventive and curative services in line with NTP and recognized humanitarian priorities and in close coordination with the WHO and health cluster coordination mechanisms.
Addressing TB among migrants: Four key building blocks