Aula Abbara1, Mohamed Almalla2, Ibrahim AlMasri3, Hussam AlKabbani4, Nabil Karah5, Wael El-Amin6, Latha Rajan7, Ibrahim Rahhal8, Mohammad Alabbas9, Zaher Sahloul10, Ahmad Tarakji11, Annie Sparrow12. 1. Imperial College, London, UK. Electronic address: Aula.abbara@gmail.com. 2. American University of Beirut, Beirut, Lebanon. Electronic address: mhdmalla@gmail.com. 3. O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada. Electronic address: Ibrahim.almasri@ucalgary.ca. 4. Department of Health and Nutrition Al-Ameen for Humanitarian Support, Gaziantep, Turkey. Electronic address: beshr.k@alameen.org. 5. Department of Molecular Biology, Laboratory for Molecular Infection Medicine Sweden, and Umea Centre for Microbial Research, Umea, Sweden. Electronic address: nabil.karah@umu.se. 6. King's College Hospital London, United Arab Emirates. Electronic address: Wael.elamin@nhs.net. 7. Tulane University School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA. Electronic address: lrajan@tulane.edu. 8. Hand in Hand for Aid and Development, Gaziantep, Turkey. Electronic address: i.rahhal@hihfad.org. 9. Hand in Hand for Aid and Development, Gaziantep, Turkey. Electronic address: M.alabbas@hihfad.org. 10. Department of Pulmonology and Critical Care, University of Illinois, Chicago, IL, USA. Electronic address: Mohammed.sahloul@advocatehealth.com. 11. Syrian American Medical Society, Washington DC, USA. Electronic address: ahmad.tarakji@sams-usa.net. 12. Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, USA. Electronic address: annie.sparrow@mssm.edu.
Abstract
OBJECTIVES: Syria's protracted conflict has resulted in ideal conditions for the transmission of tuberculosis (TB) and the cultivation of drug-resistant strains. This paper compares TB control in Syria before and after the conflict using available data, examines the barriers posed by protracted conflict and those specific to Syria, and discusses what measures can be taken to address the control of TB in Syria. RESULTS: Forced mass displacement and systematic violations of humanitarian law have resulted in overcrowding and the destruction of key infrastructure, leading to an increased risk of both drug-sensitive and resistant TB, while restricting the ability to diagnose, trace contacts, treat, and follow-up. Pre-conflict, TB in Syria was officially reported at 22 per 100 000 population; the official figure for 2017 of 19 per 100 000 is likely a vast underestimate given the challenges and barriers to case detection. Limited diagnostics also affect the diagnosis of multidrug- and rifampicin-resistant TB, reported as comprising 8.8% of new diagnoses in 2017. CONCLUSIONS: The control of TB in Syria requires a multipronged, tailored, and pragmatic approach to improve timely diagnosis, increase detection, stop transmission, and mitigate the risk of drug resistance. Solutions must also consider vulnerable populations such as imprisoned and besieged communities where the risk of drug resistance is particularly high, and must recognize the limitations of national programming. Strengthening capacity to control TB in Syria with particular attention to these factors will positively impact other parallel conditions; this is key as attention turns to post-conflict reconstruction.
OBJECTIVES: Syria's protracted conflict has resulted in ideal conditions for the transmission of tuberculosis (TB) and the cultivation of drug-resistant strains. This paper compares TB control in Syria before and after the conflict using available data, examines the barriers posed by protracted conflict and those specific to Syria, and discusses what measures can be taken to address the control of TB in Syria. RESULTS: Forced mass displacement and systematic violations of humanitarian law have resulted in overcrowding and the destruction of key infrastructure, leading to an increased risk of both drug-sensitive and resistant TB, while restricting the ability to diagnose, trace contacts, treat, and follow-up. Pre-conflict, TB in Syria was officially reported at 22 per 100 000 population; the official figure for 2017 of 19 per 100 000 is likely a vast underestimate given the challenges and barriers to case detection. Limited diagnostics also affect the diagnosis of multidrug- and rifampicin-resistant TB, reported as comprising 8.8% of new diagnoses in 2017. CONCLUSIONS: The control of TB in Syria requires a multipronged, tailored, and pragmatic approach to improve timely diagnosis, increase detection, stop transmission, and mitigate the risk of drug resistance. Solutions must also consider vulnerable populations such as imprisoned and besieged communities where the risk of drug resistance is particularly high, and must recognize the limitations of national programming. Strengthening capacity to control TB in Syria with particular attention to these factors will positively impact other parallel conditions; this is key as attention turns to post-conflict reconstruction.
Authors: Ryan B Simpson; Sofia Babool; Maia C Tarnas; Paulina M Kaminski; Meghan A Hartwick; Elena N Naumova Journal: J Public Health Policy Date: 2022-05-25 Impact factor: 3.526
Authors: Farman Ullah Khan; Faiz Ullah Khan; Khezar Hayat; Jie Chang; Muhammad Kamran; Asad Khan; Usman Rashid Malik; Asif Khan; Yu Fang Journal: Int J Environ Res Public Health Date: 2021-11-15 Impact factor: 3.390