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Conflict and Health
Published in: Conflict and Health 1/2010

Open Access 01-12-2010 | Research

Armed conflicts have an impact on the spread of tuberculosis: the case of the Somali Regional State of Ethiopia

Authors: Abdi A Gele, Gunnar A Bjune

Published in: Conflict and Health | Issue 1/2010

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Abstract

A pessimistic view of the impact of armed conflicts on the control of infectious diseases has generated great interest in the role of conflicts on the global TB epidemic. Nowhere in the world is such interest more palpable than in the Horn of Africa Region, comprising Ethiopia, Somalia, Eritrea, Djibouti, Kenya and Sudan. An expanding literature has demonstrated that armed conflicts stall disease control programs through distraction of health system, interruption of patients' ability to seek health care, and the diversion of economic resources to military ends rather than health needs. Nonetheless, until very recently, no research has been done to address the impact of armed conflict on TB epidemics in the Somali Regional State (SRS) of Ethiopia.

Methods

This study is based on the cross-sectional data collected in 2007, utilizing structured questionnaires filled-out by a sample of 226 TB patients in the SRS of Ethiopia. Data was obtained on the delay patients experienced in receiving a diagnosis of TB, on the biomedical knowledge of TB that patients had, and the level of self-treatment by patients. The outcome variables in this study are the delay in the diagnosis of TB experienced by patients, and extent of self-treatment utilized by patients. Our main explanatory variable was place of residence, which was dichotomized as being in 'conflict zones' and in 'non-conflict zones'. Demographic data was collected for statistical control. Chi-square and Mann-Whitney tests were used on calculations of group differences. Logistic regression analysis was used to determine the association between outcome and predictor variables.

Results

Two hundred and twenty six TB patients were interviewed. The median delay in the diagnosis of TB was 120 days and 60 days for patients from conflict zones and from non-conflict zones, respectively. Moreover, 74% of the patients residing in conflict zones undertook self-treatment prior to their diagnosis. The corresponding proportion from non-conflict zones was 45%. Fully adjusted logistic regression analysis shows that patients from conflict zones had significantly greater odds of delay (OR = 3.06; 95% CI: 1.47-6.36) and higher self treatment utilization (OR = 3.34; 95% CI: 1.56-7.12) compared to those from non-conflict zones.

Conclusion

Patients from conflict zones have a longer delay in receiving a diagnosis of TB and have higher levels of self treatment utilization. This suggests that access to TB care should be improved by the expansion of user friendly directly observed therapy short-course (DOTS) in the conflict zones of the region.
Appendix
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Literature
1.
WHO: Strategic Plan for Tuberculosis Control for the African Region: 2006-2010. 2007, Geneva, World Health Organization
2.
WHO: Global tuberculosis control: surveillance, planning, financing. 2006
3.
Waldman RJ: Public health in times of war and famine: what can be done? What should be done?. JAMA. 2001, 286 (5): 588-90. 10.1001/jama.286.5.588.CrossRefPubMed
4.
Smallman-Raynor MR, Cliff AD: War epidemics: A historical geography of infectious diseases in military conflict and civil strife. 2004, Oxford University Press Inc; New York
5.
WHO: World Report on Violence and Health. 2002, World Health Organization: Geneva
6.
Armstrong DB: Civilian tuberculosis control following war conditions. The American Journal of Public Health. 1918, 897-904. 10.2105/AJPH.8.12.897.
7.
Barr RG, Menzies R: The effect of war on tuberculosis. Results of a tuberculin survey among displaced persons in El Salvador and a review of the literature. Tuber Lung Dis. 1994, 75 (4): 251-9. 10.1016/0962-8479(94)90129-5.CrossRefPubMed
8.
Coninx R: Tuberculosis in complex emergencies. Bulletin of the World Health Organization. 2007, 85 (8): 569-648. 10.2471/BLT.06.037630.CrossRef
9.
Tiwari SK, Sitthi-ammorn C, Wang JL, Kasetjaroen Y, Love EJ: Prevalence of TB and service utilization in conflict affected areas of Nebal. Journal of Nebal Health Research Counsil. 2005, 3 (1): 45-57.
10.
11.
Omoigui N: Public Health Implications of conflicts in Africa. 2006
12.
Devereux S: Vulnerable Livelihoods in Somali Region, Ethiopia. 2006
13.
Dualeh M: Health Services for the drought-affected populations in the Somali National Regional State (Gode, Denan and Jijiga). 2000
14.
15.
Human Rights Watch: Collective punishment: War Crimes and Crimes against Humanity in the Ogaden area of Ethiopia's Somali Regional State. 2008
16.
United Nations Office for Coordination of Humaniterian Affiars: Somali Region update. Humanitarian Bulletin. 2008
17.
Doctors Without Borders: Obstructions Lead MSF-Switzerland to Withdraw from FIIQ, Somali Region of Ethiopia. 2008
18.
Healy S: Conflict in the Ogaden and its Regional dimensions. 2007, Chatham House: Center of African Studies
19.
Yimer S, Bjune G, Alene G: Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC Infect Dis. 2005, 5: 112-10.1186/1471-2334-5-112.PubMedCentralCrossRefPubMed
20.
Cambanis A, Ramsay A, Yassin MA, Cuevas LE: Duration and associated factors of patient delay during tuberculosis screening in rural Cameroon. Trop Med Int Health. 2007, 12 (11): 1309-14.CrossRefPubMed
21.
22.
Madebo T, Lindtjorn B: Delay in Treatment of Pulmonary Tuberculosis: An Analysis of Symptom Duration Among Ethiopian Patients. Med Gen Med. 1999, E6.
23.
Agutu WO: Short-course tuberculosis chemotherapy in rural Somalia. East Afr Med J. 1997, 74 (6): 348-52.PubMed
24.
25.
Barr RG, Menzies R: The effect of war on tuberculosis. Tubercle Lung Dis. 1994, 75: 251-9. 10.1016/0962-8479(94)90129-5.CrossRef
26.
Toole MJ, Galson S, Brady W: Are war and public health compatible?. Lancet. 1993, 341: 1193-6. 10.1016/0140-6736(93)91013-C.CrossRefPubMed
27.
28.
29.
USAID: Tuberculosis profile of Ethiopia. 2009
30.
Ponsar F, Ford N, Van HM, Mancini S, Bachy C: Mortality, violence and access to care in two districts of Port-au-Prince, Haiti. Confl Health. 2009, 3: 4-10.1186/1752-1505-3-4.PubMedCentralCrossRefPubMed
31.
Demissie M, Lindtjorn B, Berhane Y: Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health. 2002, 2: 23-10.1186/1471-2458-2-23.PubMedCentralCrossRefPubMed
32.
Cambanis A, Yassin MA, Ramsay A, Bertel SS, Arbide I, Cuevas LE: Rural poverty and delayed presentation to tuberculosis services in Ethiopia. Trop Med Int Health. 2005, 10 (4): 330-5. 10.1111/j.1365-3156.2005.01393.x.CrossRefPubMed
33.
Mesfin MM, Newell JN, Walley JD, Gessessew A, Madeley RJ: Delayed consultation among pulmonary tuberculosis patients: a cross sectional study of 10 DOTS districts of Ethiopia. BMC Public Health. 2009, 9: 53-10.1186/1471-2458-9-53.PubMedCentralCrossRefPubMed
34.
Tiwari K, Love E, Sitthi-Amorn C: Tuberculosis Treatment Services in Armed Conflict Areas: Does Access Matter?. Int Med J. 2006, 13 (3): 163-9.
35.
WHO: Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978. 1978
36.
Sagbakken M, Frich JC, Bjune GA: Perception and management of tuberculosis symptoms in Addis Ababa, Ethiopia. Qual Health Res. 2008, 18 (10): 1356-66. 10.1177/1049732308322596.CrossRefPubMed
37.
Barker RD, Millard FJ, Malatsi J, Mkoana L, Ngoatwana T, Agarawal S: Traditional healers, treatment delay, performance status and death from TB in rural South Africa. Int J Tuberc Lung Dis. 2006, 10 (6): 670-5.PubMed
38.
Tuon FF, Amato VS: Neglected tropical diseases: beyond the wars. Rev Inst Med Trop Sao Paulo. 2008, 50 (5): 313-4.CrossRefPubMed
39.
Nunn P, Harries A, Godfrey-Faussett P, Gupta R, Maher D, Raviglione M: The research agenda for improving health policy systems performance and service delivery for tuberculosis control: a WHO perspective. Bull World Health Organ. 2002, 80: 471-6.PubMedCentralPubMed
40.
WHO: WHO country cooperation strategy: Ethiopa; 2002-2005. 2001
41.
Sawert H: Economic considerations for TB control. Edited by: Lee B Reichman, Earl S Hershfield. 2000, Tuberculosis: a comprehensive international approach, 799-810.
42.
Rodger AJ, Toole M, Lalnuntluangi B, Muana V, Deutschmann P: DOTS-based tuberculosis treatment and control during civil conflict and an HIV epidemic, Churachandpur District, India. Bull World Health Organ. 2002, 80 (6): 451-6.PubMedCentralPubMed
Metadata
Title
Armed conflicts have an impact on the spread of tuberculosis: the case of the Somali Regional State of Ethiopia
Authors
Abdi A Gele
Gunnar A Bjune
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Conflict and Health / Issue 1/2010
Electronic ISSN: 1752-1505
DOI
https://doi.org/10.1186/1752-1505-4-1

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