|Tuberculosis Control in Refugee Situations - An Inter-Agency Field Manual (World Health Organisation, 1997, 72 p.)|
This Manual is intended to inform operational agencies, donor agencies and field managers of the issues related to TB control in refugee situations. The Manual will serve as a tool in the implementation, monitoring and evaluation of TB control programmes in refugee situations.
TB control is not a priority in the immediate emergency phase when mortality and malnutrition rates are high due to measles, diarrhoeal disease, meningitis, and malaria. The priorities during this phase are the provision of adequate food, water, shelter, sanitation, basic drugs and the control of common acute communicable diseases.
A TB control programme should not commence until death rates have been reduced to less than 1 per 10,000 population per day, basic needs are provided, and essential clinical services and supplies are available.
A TB control programme should be implemented only if the security situation is stable and the camp population are expected to remain for at least 6 months. Funding should be available for at least 12 months, along with sufficient medical supplies and trained staff.
Since TB is more common, both in countries of origin and in host countries, the involvement of the national TB programme (NTP) of the host country in the implementation of the TB programme is essential.
The priority of a TB control programme is to identify and treat infectious patients, and ensure that they become non-infectious as soon as possible. Successful cure of infectious patients will reduce transmission and prevent new patients from occurring. Patients become non-infectious within two weeks of commencing the treatment if drugs are taken regularly.
In addition to smear-positive pulmonary TB patients, severely ill patients with non-pulmonary TB are to be treated in the TB programme. Other non-infectious TB patients should not be included the TB programme until it has demonstrated that cure rates are satisfactory.
The recommended strategy for curing infectious TB patients is the WHO TB control strategy (DOTS), which is implemented by providing the correct combination of TB drugs for 6 or 8 months, and observing patients swallowing their medicines. This is especially important during the first two months of treatment.
TB patients co-infected with HIV respond well to standard TB treatment. Since TB is more common in HIV infected individuals, and because many refugees and displaced persons may come from, or seek refuge in, countries with a high prevalence of HIV infection, TB control and HIV programmes should be carefully coordinated.
TB is an energy wasting disease. Many refugees may also be suffering from malnutrition which is exacerbated by TB. TB treatment will normally lead to an increased need for calories, therefore nutritional rehabilitation may be an important component of a TB control programme in refugee situations.
TB control programmes should be integrated into the primary health care services for the refugee population; however, a TB Coordinator should be appointed for approximately every 50,000 refugees.