title: Tuberculosis among health-care workers in low- and middle-income countries: a systematic review.
abstract: BACKGROUND
  The risk of transmission of Mycobacterium tuberculosis from patients to health-care workers (HCWs) is a neglected problem in many low- and middle-income countries (LMICs). Most health-care facilities in these countries lack resources to prevent nosocomial transmission of tuberculosis (TB).
  
  
  RESULTS
  We conducted a systematic review to summarize the evidence on the incidence and prevalence of latent TB infection (LTBI) and disease among HCWs in LMICs, and to evaluate the impact of various preventive strategies that have been attempted. To identify relevant studies, we searched electronic databases and journals, and contacted experts in the field. We identified 42 articles, consisting of 51 studies, and extracted data on incidence, prevalence, and risk factors for LTBI and disease among HCWs. The prevalence of LTBI among HCWs was, on average, 54% (range 33% to 79%). Estimates of the annual risk of LTBI ranged from 0.5% to 14.3%, and the annual incidence of TB disease in HCWs ranged from 69 to 5,780 per 100,000. The attributable risk for TB disease in HCWs, compared to the risk in the general population, ranged from 25 to 5,361 per 100,000 per year. A higher risk of acquiring TB disease was associated with certain work locations (inpatient TB facility, laboratory, internal medicine, and emergency facilities) and occupational categories (radiology technicians, patient attendants, nurses, ward attendants, paramedics, and clinical officers).
  
  
  CONCLUSIONS
  In summary, our review demonstrates that TB is a significant occupational problem among HCWs in LMICs. Available evidence reinforces the need to design and implement simple, effective, and affordable TB infection-control programs in health-care facilities in these countries.
authors.affiliation: Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Joshi
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Reingold
authors.forename: Dick
authors.initials: D
authors.lastname: Menzies
authors.forename: Madhukar
authors.initials: M
authors.lastname: Pai
mesh_terms: D000488:Allied Health Personnel / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D014943:Global Health; D006801:Humans; D015994:Incidence; D009784:Occupational Diseases / Q000191:economics* / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D013337:Students, Medical / Q000706:statistics & numerical data; D013338:Students, Nursing / Q000706:statistics & numerical data; D014374:Tuberculin Test; D014376:Tuberculosis / Q000453:epidemiology*