Name: Gustafson, Per Home Country: Denmark Research Country: Guinea Bissau Project period: 2000-2003 Type: Ph.D. thesis Title Epidemiological aspects of tuberculosis in Guinea-Bissau, West Africa Abstract A study area in Guinea Bissau, with a population of about 43,000 has been followed through a demographic census system for over 25 years. In 1996, a tuberculosis (TB) surveillance system was set up in the area; all adult cases of intrathoracic TB were included. The background data from the census system allows analyses comparing TB-cases with the whole population. The aims of the TB-studies were to evaluate risk factors for positive tuberculin skin test (TST) in the population and in TB case households, to assess incidence and risk factors for active TB, and to determine clinical predictors for death in TB patients. From 1996 to 2001 a total of 811 TB-cases were included and investigated. The risk of positive TST was closely related to previous or recent exposure to TB. BCG did not confound the interpretation of the test. TST performed during the early rainy season, from June to August, resulted in smaller reactions. Independent risk factors for active TB were male sex, older age, poverty, less schooling and adult crowding. Children in the household reduced the risk for TB. Both HIV-1 and HIV-2 infection increased the risk for TB, although the effect was considerably higher for HIV-1. A civil war 1998-1999 caused involuntary treatment interruption controls, an effect that as most marked in HIV-positive. The increased mortality in HIV-positive continued also after the war had ended. Overall, the mortality was increased for both HIV-1 and HIV-2-positive TB-cases compared to HIV-negative, although higher for HIV-1 than for HIV-2-infected. Signs of weakened immune function, such as oral candida infection, and malnutrition increased the risk of dying in both HIV-positive and HIV-negative patients. Estimating the degree of malnutrition using the mid-upper-arm circumference provided a good tool in the evaluation of increased risk for TB death. Keywords: Tuberculosis, HIV, HIV-1, HIV-2, Mycobacterium tuberculosis, epidemiology, Africa, Guinea Bissau, incidence, risk factor, case fatality rate, mortality, survival, tuberculin skin test ISBN: 91-974795-1-9. Language: English. Pages: 190. Publication year: 2003 Involved research institution(s) Department of Infectious Diseases, Malmö University Hospital, Sweden Faculty of Medicine, Lund University Projecto de Saúde de Bandim / MINSAP Republica da Guinea Bissau Danish Epidemiology Science Centre, Bissau, Guinea Bissau Department of Epidemiology Research, the State Serum Institute, Denmark Supervisor(s) Anders Nauclér, Department of Infectious Diseases, Malmö University Hospital, Sweden Peter Aaby, Department of Epidemiology, the State Serum Institute, Denmark Correspondence Department of Infectious Diseases Malmö University Hospital, SE-20502 Malmö, Sweden Email: Per_Gustafson