Tuberculosis and the role of war in the modern era

OBJECTIVE: Tuberculosis (TB) remains a major global health problem; histori cally, major wars have increased TB notifications. This study evaluated whe ther modern conflicts worldwide affected TB notifications between 1975 and 1995. DESIGN: Dates of conflicts were obtained and matched with national TB notif ication data reported to the World Health Organization. Overall notificatio n rates were calculated pre and post conflict. Poisson regression analysis was applied to all conflicts with sufficient data for detailed trend analys is. RESULTS: Thirty-six conflicts were identified, for which 3-year population and notification data were obtained. Overall crude TB notification rates we re 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 analy sis to model 5-year pre and post start of conflict trends. This analysis in dicated 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 1.01 6 (95%CI 0.9435-1.095). CONCLUSION: The modelling suggested that in the modern era war may not sign ificantly 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 sho uld be considered in planning post-conflict refugee and reconstruction prog rammes.