Increasing burden of pulmonary tuberculosis in young women

Abstract

The epidemic is best described as ‘explosive’ and occurs disproportionately among young women, with more than 60% of infections occurring in the 20 - 30-year age group. 2 As the epidemic matures there has been an increase in young adult morbidity and mortality that mirrors the observed HIV infection patterns. 3 The objective of this study was to investigate the temporal trends of pulmonary tuberculosis (PTB) at the Prince Cyril Zulu Communicable Diseases Clinic (CDC), an urban outpatient specialist TB facility in central Durban, KwaZulu-Natal. Data were extracted from the clinic’s computerised register. The chi-square test for linear trend assessed changes in the distribution of PTB from 1998 to 2004. Data on age were categorised as 0 - 19 years, 20 - 39 years, and ≥ 40 years, and the effect of gender was examined separately for each age group because of the differential impact of the HIV infection by gender and age. 2 The total number of new TB cases increased from 1998 to 2004, with an average annual increase of 13.3% per year (Table I). The total number of patient visits increased substantially, with an average annual increase of 15.2% per year (p < 0.001). Significantly more patients were either self-referred ( p < 0.001) or referred from hospitals (p < 0.001). There was a downward trend in the rate per year of PTB cases, which proportionally decreased from 70% in 1998 to 53% in 2004 (p < 0.001). While more men than women were diagnosed with PTB, the proportion of men decreased from 68% in 1998 to 60% in 2004, while the proportion of women increased from 32% in 1998 to 40% in 2004 (p < 0.001). Of note is the difference in the proportion of PTB between men and women by age (Fig. 1); in the 20 - 39-year age group the proportion of women