Tuberculosis in Bissau: incidence and risk factors in an urban community in sub-Saharan Africa.
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 (>or=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.
Gustafson
Per
P
Projecto de Saúde de Bandim, Danish Epidemiology Science Centre, Bissau, Guinea-Bissau. per.gustafson@inf.mas.lu.se
Gomes
Victor F
VF
Vieira
Cesaltina S
CS
Rabna
Paulo
P
Seng
Rémonie
R
Johansson
Peter
P
Sandström
Anita
A
Norberg
Renée
R
Lisse
Ida
I
Samb
Badara
B
Aaby
Peter
P
Nauclér
Anders
A
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D017678:Sex Distribution; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology*; D014505:Urban Population