title: Tuberculosis among transhumant pastoralist and settled communities of south-eastern Mauritania.
abstract: BACKGROUND
  Transhumant pastoralists of Mauritania were assumed to have a high prevalence of tuberculosis (TB) because of reduced access to diagnostic testing. No population-based survey on TB has been published for Mauritania.
  
  
  OBJECTIVE
  The goal of this study was to estimate the prevalence of presumptive TB cases among mobile pastoralists and villagers in a remote zone of Mauritania.
  
  
  METHODS
  In the south-eastern province of Hodh Ech Chargui, 250 adult pastoralists and 250 villagers were randomly enrolled using multistage cluster sampling in February 2012. A TB centre nurse examined participants using a standard clinical protocol, and a participant questionnaire was completed. Focus group discussions and interviews were conducted with community members and health personnel, respectively.
  
  
  RESULTS
  Fourteen new presumptive TB cases were identified, leading to an overall prevalence of 2.8%, (95% confidence interval (CI) 1.5-4.7%). The prevalence was non-significantly higher among villagers than pastoralists (3.6% vs. 2.0%). Assuming illness duration was 3 years and all presumptive cases started treatment, an overall crude incidence of 933 cases/100,000 was derived. Five of six presumptive cases in Djiguenni were confirmed by sputum smear microscopy, but none out of eight presumptive cases were confirmed in Néma, although the same nurse performed all clinical examinations in both departments. This result was attributed to the use of expired reagents in Néma. Communities mentioned distance rather than lack of information as the main constraint to seeking diagnosis, but poor diagnostic centre performance also delayed decision-making.
  
  
  CONCLUSIONS
  TB prevalences were high among both pastoralists and villagers. None of the 14 presumptive cases sought prior diagnostic testing. TB diagnostic centres in the remote rural study zone were poorly equipped. These centres must remain in operation to reduce TB incidence in vulnerable communities in insecure remote rural zones and to reach national health goals.
authors.affiliation: Institut de Santé et Développement, University Cheikh Anta Diop, Dakar, Senegal.|National Institute of Public Health Research, Nouakchott, Mauritania.
authors.forename: Aissata
authors.initials: A
authors.lastname: Lô
authors.affiliation: Institut de Santé et Développement, University Cheikh Anta Diop, Dakar, Senegal.
authors.forename: Anta
authors.initials: A
authors.lastname: Tall-Dia
authors.affiliation: Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
authors.forename: Bassirou
authors.initials: B
authors.lastname: Bonfoh
authors.affiliation: Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Basel, Switzerland.|Swiss TPH and the University of Basel, Basel, Switzerland; esther.schelling@unibas.ch.
authors.forename: Esther
authors.initials: E
authors.lastname: Schelling
mesh_terms: D000293:Adolescent; D000328:Adult; D000822:Animal Husbandry; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D006801:Humans; D015994:Incidence; D008297:Male; D008435:Mauritania / Q000453:epidemiology; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015995:Prevalence; D012423:Rural Health; D011795:Surveys and Questionnaires; D014171:Transients and Migrants; D014376:Tuberculosis / Q000453:epidemiology*; D055815:Young Adult
keywords: Mauritania; diagnostic capacity; pastoralists; presumptive TB cases; tuberculosis