International Journal of Epidemiology, Volume 33, Number 1, pp. 163-172
IJE vol.33 no.1 © International Epidemiological Association 2004; all rights reserved.
Infectious Diseases |
Tuberculosis in Bissau: incidence and risk factors in an urban community in sub-Saharan Africa
1 Projecto de Saúde de Bandim, Danish Epidemiology Science Centre, Bissau, Guinea-Bissau
2 Department of Infectious Diseases, Malmö University Hospital, Sweden
3 Hospital Raoul Follereau, Bissau, Guinea-Bissau
4 Laboratório Nacional de Saúde Pública, Bissau, Guinea Bissau
5 IMEA and INSERM U88, Paris and St-Maurice, France
6 Swedish Institute for Infectious Disease Control, Stockholm, Sweden
7 Department of Public Health and Clinical Medicine, University of Umeå, Sweden
Correspondence: Dr Per Gustafson, Department of Infectious Diseases, Malmö University Hospital, SE-205 02 Malmö, Sweden. E-mail: per.gustafson{at}inf.mas.lu.se
Background Despite the long history of tuberculosis (TB) research, population-based studies from developing countries are rare.
Methods In a prospective community study in Bissau, the capital of Guinea-Bissau, we assessed the impact of demographic, socioeconomic and cultural risk factors on active TB. A surveillance system in four districts of the capital identified 247 adult (
15 years) cases of intrathoracic TB between May 1996 and June 1998. Risk factors were evaluated comparing cases with the 25 189 adults living in the area in May 1997.
Results The incidence of intrathoracic TB in the adult population was 471 per 100 000 person-years. Significant risk factors in a multivariate analysis were increasing age (P < 0.0001), male sex (odds ratio [OR] = 2.58, 95% CI: 1.85, 3.60), ethnic group other than the largest group (Pepel) (OR = 1.64, 95% CI: 1.20, 2.22), adult crowding (OR = 1.68, 95% CI: 1.18, 2.39 for >2 adults in household), and poor quality of housing (OR = 1.66, 95% CI: 1.24, 2.22). Household type was important; adults living alone or with adults of their own sex only, had a higher risk of developing TB than households with husband and wife present, the adjusted OR being 1.76 (95% CI: 1.11, 2.78) for male households and 3.80 (95% CI: 1.69, 8.56) for female households. In a multivariate analysis excluding household type, child crowding was a protective factor, the OR being 0.68 (95% CI: 0.51, 0.90) for households with >2 children per household.
Conclusions Bissau has a very high incidence of intrathoracic TB. Human immunodeficiency virus (HIV), increasing age, male sex, ethnicity, adult crowding, family structure, and poor housing conditions were independent risk factors for TB. Apart from HIV prevention, TB control programmes need to emphasize risk factors such as socioeconomic inequality, ethnic differences, crowding, and gender.
Keywords Tuberculosis, HIV infection, incidence, risk factor, sub-Saharan, Africa, community study
Accepted 28 August 2003
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