Abstract
Limited attention has been made by countries of ‘new immigration’ to define an immigration medical examination requirement of inbound migrant flows. Importation of TB through inbound migration routes have been a largely neglected strategy in TB control in Sri Lanka despite increasing migrant flows from endemic regions. We contend that establishing a health assessment for those long stay resident visa applicants to Sri Lanka may be useful in mitigating the spread of TB. However the approach should harness a ‘rights based’ approach to health assessment, and also be linked to the national health system. In this way the assessment becomes a vital mechanism for global public health good rather than be perceived as a tool for discrimination or immigration control. Migrants need to be included in national and global TB control strategies, especially since mobility is a key feature of the post-2015 Millennium Development Goals agenda. DOI: http://dx.doi.org/10.4038/sljid.v4i2.6719 Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):67-76
Highlights
Limited attention has been made by countries of ‘new immigration’ to define an immigration medical examination requirement of inbound migrant flows
A systematic review and meta-analysis to determine the yield for pulmonary tuberculosis among new immigrants at the point of entry was established at 3.5 cases per 1,000 screened.[3]
Our analysis shows that 54% of resident visa applicants arrive from high TB prevalent countries, out
Summary
In the development of a framework for migration health assessment for in-bound migrants, one of the main challenges would be to identify the best suitable model for Sri Lanka. The experience from UK has shown that TB assessment of migrants at point of entry using radiological assessment proved challenging to implement and resulted in a very small detection threshold of active TB cases.[13] The third option is post-arrival screening where the screening occurs within a few weeks of migrant arriving in the receiving country through the maintenance of a quality TB screening service with supportive facilities for TB treatment and referral care. Xpert-MTB Rif, the molecular testing method for sputum, provides results in two hours for TB as well as for rifampicin resistance which is a proxy indicator for MDR-TB.[43] Xpert-MTB Rif is ideal for migrant TB screening where rapid results are required and for testing individuals from high MDR-TB settings Whilst such genomic technologies are powerful, cost implications may prohibit its use in district health systems. It is recommended that interventional research, feasibility and costing studies be undertaken to evaluate its use, if Xpert-MTB Rif is to be utilized for routine screening purposes in Sri Lanka
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