Extra-pulmonary tuberculosis incidence, trends and predictions in Monastir, Tunisia (2000-2030)

Abstract

Abstract Background Tuberculosis (TB) is global public health problem and up to 25% of TB cases present extrapulmonary involvement. The incidence of extrapulmonary tuberculosis (EPTB) is increased worldwide. Our study aimed to give an update on the epidemiology, current trends of EPTB from 2000 to 2017 and to predict future trajectories of EPTB up to 2030 in Monastir, Tunisia. Methods We performed an observational study from 2000 to 2017. Data were collected by the regional direction of primary health care. Incidence was estimated by the crude incidence rate (CIR). Poisson regression model was used to calculate the slope 'b' in order to describe trends and was performed to estimate incidence projection for 2030. Data were verified and analyzed using IBM SPSS Statistics version 22.0 software. Results During 18 years, 997 cases of TB were declared in Monastir. Almost 51% (n = 509) were EPTB. Sex ratio was 1.68. The main EPTB forms were lymph nodes in 234 (23.5%) cases, followed by pleural TB in 35 (3.5%) cases and bone and joints in 31 (3.1%) cases. CIR was 5.62/100,000 inhabitants (inh) for EPTB with a highest incidence in patients aged 60 years and above. A positive trend was showed for EPTB with a (b = 0.05; p < 0.0001) especially for lymph node localization. Up to 2030, EPTB would be increasing with an estimated incidence rate of 9.11/100,000 inh. Regarding lymph node TB, cases may continue to rise with an estimated incidence rate of 7.96 /100,000 inh. Conclusions Despite the availability of a treatment and knowledge on prevention measures, EPTB remains a public health problem. Thus, investigating and identifying patients at higher risk is needed in order to improve its management. Key messages Updated epidemiology is important for healthcare experts to improve planning policies attributed to EPTB. Our results are a tool for decision-makers to assess the efficiency of TB control programs.