The Effect of Environmental Exposures on the Diagnosis of Tuberculosis in Syrian Refugees.

Objective: Humanitarian crisis in the Middle East geography has brought refugees into being. The aim of this study is to investigate the relationship between refugees' tuberculosis diagnosis process and air pollution parameters and environmental exposures.

Methods: A total of 229 patients with tuberculosis registered at Şanlıurfa Tuberculosis Dispensary during 2012-2018 were included. In this cross-sectional study, education levels, smoking status, warm-up style, and exposure to biomass, pesticides, dust storm, PM10, and sulfur dioxide were evaluated. Air parameters were received from https://www.havaizleme.gov.tr/. Bacteriological diagnosis was classified as smear-positive lung tuberculosis, smear-negative culture-positive lung tuberculosis, and other diagnostic methods. This study was approved by the Harran University Ethical Committee (10.12.2018; session: 12; decision no: 36).

Results: Of the 229 patients diagnosed with tuberculosis, 53.3% were males and 46.7% were females. The average age was 31.15 ± 15.16. About 24.5% of refugees lived in camps, while 75.5% lived outside of the camps. The rate of smear (+) lung tuberculosis was 38% and smear (-) culture (+) lung tuberculosis was 14.4%. Smoking (P = .007) in smear (+) cases and exposure to PM10 (P = .036) and sulfur dioxide (P = .015) in culture (+) cases were significant.

Conclusion: Smoking and air pollution are associated with delayed diagnosis of tuberculosis and severe forms of tuberculosis. We think that as a result of smoking cessation and reduction of air pollution, tuberculosis incidence in refugees can be reduced.