Abstract
Tuberculosis (TB) case notification rates in Vietnam have stabilized since 2000, but in 2007 were increasing among young adults. The emerging HIV epidemic only partly explains this increase. Other factors are probably involved. We aimed to assess whether rural-to-urban migration is such a factor. We conducted a case-control study at district TB units (DTUs) in Da Nang province, Vietnam, recruiting equal numbers (170) of TB patients aged 15-35 years, TB suspects of the same age in whom TB was excluded, and TB patients of 35 years and older. Risk factors for TB were assessed through interviews using pre-structured questionnaires. Among persons seeking care at DTUs, migration was not a significant risk factor for TB. Young male migrants had a lower risk of TB than other young adults (odds ratio (OR) 0.4; 95% confidence interval (95%CI) 0.03-0.64). Instead, TB was associated with male sex and a higher level of education. Compared to older TB patients, younger TB patients were more likely to be female, have a higher education level and a job involving indoor contacts with other people. Migration does not account for the increase in TB case notification rates among young adults in Vietnam. However, migration cannot be excluded as a risk factor for TB in Vietnam, because migrants may not seek diagnosis and treatment for TB at DTUs.
Highlights
BackgroundWith an annual incidence of 180 new tuberculosis (TB) cases per 100,00 inhabitants, Vietnam is one of the 22 high burden countries that account for 80% of all new TB cases each year worldwide [1].The recommended strategy to fight TB, called the directly observed therapy, short course (DOTS) strategy was implemented in 1986 in Vietnam
Among those visiting a district TB unit (DTU) in Da Nang province for TB suggestive symptoms, we recruited young adults aged 15-34 years diagnosed with TB, TB patients aged 35 years and over, and young adults aged 15-34 years who were found not to suffer from TB based on chest X-ray (CXR) result and sputum smear examination (TB suspects)
Based on observations during a monitoring visit towards the end of data collection, we could estimate that about 185 young TB patients, 192 older TB patients and 370 TB-free controls had been invited to participate in this study, resulting in estimated response rates of 91.9%, 88.5% and 45.9%, respectively
Summary
BackgroundWith an annual incidence of 180 new tuberculosis (TB) cases (all forms) per 100,00 inhabitants, Vietnam is one of the 22 high burden countries that account for 80% of all new TB cases each year worldwide [1].The recommended strategy to fight TB, called the directly observed therapy, short course (DOTS) strategy (later revised and broadened to the Stop TB Strategy [2]) was implemented in 1986 in Vietnam. With an annual incidence of 180 new tuberculosis (TB) cases (all forms) per 100,00 inhabitants, Vietnam is one of the 22 high burden countries that account for 80% of all new TB cases each year worldwide [1]. Since 1996, Vietnam has reached the Stop TB targets (i.e., detection of at least 70% of all new smear-positive TB cases and cure of at least 85% of these) [2]. Meeting these targets was thought to lead to 11% annual reduction in TB incidence rate [4]. Since 1990 the case notification rates in Vietnam stabilized rather than declined [5]. After 2007, a weak decrease in case notification and estimated incidence rates becomes visible [1]
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