Tuberculosis control in refugee populations: a challenge to both relief agencies and national programs

Today's worldwide tuberculosis epidemic and the movement of a growing number of refugees overlap geographically and have made tuberculosis control in refugee populations an issue of increasing importance. However, in developing countries, where both of these problems are concentrated, tuberculosis control in refugee populations remains a largely unmet need. Experience shows that despite difficult field conditions, tuberculosis control programs can be managed successfully in this setting. The range of outcome results reported for treatment completion and defaulting is, however, wide. Analyzing possible determinants for observed variation in treatment outcome results, this paper outlines prerequisites for establishing a tuberculosis control program in a refugee setting. An attempt is made to formulate a general strategy for the main policies which, if applied consistently, will reduce morbidity, mortality and transmission of tuberculosis among refugee populations living in camps. Criteria for the evaluation and monitoring of such a program are discussed.