Tuberculosis and the role of war in the modern era.
OBJECTIVE
Tuberculosis (TB) remains a major global health problem; historically, major wars have increased TB notifications. This study evaluated whether modern conflicts worldwide affected TB notifications between 1975 and 1995.


METHODS
Dates of conflicts were obtained and matched with national TB notification data reported to the World Health Organization. Overall notification rates were calculated pre and post conflict. Poisson regression analysis was applied to all conflicts with sufficient data for detailed trend analysis.


RESULTS
Thirty-six conflicts were identified, for which 3-year population and notification data were obtained. Overall crude TB notification rates were 81.9 and 105.1/100,000 pre and post start of conflict in these countries. Sufficient data existed in 16 countries to apply Poisson regression analysis to model 5-year pre and post start of conflict trends. This analysis indicated that the risk of presenting with TB in any country 2.5 years after the outbreak of conflict relative to 2.5 years before the outbreak was 1.016 (95%CI 0.9435-1.095).


CONCLUSIONS
The modelling suggested that in the modern era war may not significantly damage efforts to control TB in the long term. This might be due to the limited scale of most of these conflicts compared to the large-scale civilian disruption associated with 'world wars'. The management of TB should be considered in planning post-conflict refugee and reconstruction programmes.
Drobniewski
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FA
Dulwich Public Health Laboratory, Guy's King's and St Thomas' Medical School, King's College Hospital (Dulwich), London, UK. francis.drobniewski@kcl.ac.uk
Verlander
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NQ
D018563:Disease Notification / Q000706:statistics & numerical data; D014943:Global Health; D006801:Humans; D008962:Models, Theoretical; D016012:Poisson Distribution; D012044:Regression Analysis; D012306:Risk; D014376:Tuberculosis / Q000453:epidemiology*; D014857:Warfare