title: Tuberculosis in migrant populations. A systematic review of the qualitative literature.
abstract: BACKGROUND
  The re-emergence of tuberculosis (TB) in low-incidence countries and its disproportionate burden on immigrants is a public health concern posing specific social and ethical challenges. This review explores perceptions, knowledge, attitudes and treatment adherence behaviour relating to TB and their social implications as reported in the qualitative literature.
  
  
  METHODS
  Systematic review in four electronic databases. Findings from thirty selected studies extracted, tabulated, compared and synthesized.
  
  
  RESULTS
  TB was attributed to many non-exclusive causes including air-born transmission of bacteria, genetics, malnutrition, excessive work, irresponsible lifestyles, casual contact with infected persons or objects; and exposure to low temperatures, dirt, stress and witchcraft. Perceived as curable but potentially lethal and highly contagious, there was confusion around a condition surrounded by fears. A range of economic, legislative, cultural, social and health system barriers could delay treatment seeking. Fears of deportation and having contacts traced could prevent individuals from seeking medical assistance. Once on treatment, family support and "the personal touch" of health providers emerged as key factors facilitating adherence. The concept of latent infection was difficult to comprehend and while TB screening was often seen as a socially responsible act, it could be perceived as discriminatory. Immigration and the infectiousness of TB mutually reinforced each another exacerbating stigma. This was further aggravated by indirect costs such as losing a job, being evicted by a landlord or not being able to attend school.
  
  
  CONCLUSIONS
  Understanding immigrants' views of TB and the obstacles that they face when accessing the health system and adhering to a treatment programme-taking into consideration their previous experiences at countries of origin as well as the social, economic and legislative context in which they live at host countries- has an important role and should be considered in the design, evaluation and adaptation of programmes.
authors.affiliation: Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: Abarca Tomás
authors.affiliation: Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain ; Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Christopher
authors.initials: C
authors.lastname: Pell
authors.affiliation: Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain ; Service of Preventive Medicine, San Cecilio University Hospital, Granada, Spain ; Consorcio de Investigación Biomédica en Red en Epidemiología y Salud Públic, (CIBERESP), Madrid, Spain.
authors.forename: Aurora
authors.initials: A
authors.lastname: Bueno Cavanillas
authors.affiliation: Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain ; Service of Preventive Medicine, San Cecilio University Hospital, Granada, Spain ; Consorcio de Investigación Biomédica en Red en Epidemiología y Salud Públic, (CIBERESP), Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Guillén Solvas
authors.affiliation: Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain ; Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Pool
authors.affiliation: Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Roura
mesh_terms: D054242:Emigrants and Immigrants; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D010342:Patient Acceptance of Health Care; D014171:Transients and Migrants; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control