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Tuberkulose blandt børn og unge i arktis: set fra et grønlandsk perspektiv
Nordic Council of Ministers, Nordic School of Public Health NHV.
2008 (Danish)Independent thesis Advanced level (degree of Master (Two Years))Student thesisAlternative title
Tuberculosis among children and youth in the arctic : from a Greenlandic point of view (English)
Abstract [da]

Introduktion: Tuberkulose er fortsat en sygdom, man skal tage alvorligt i Grønland. Forekomsten er høj med 150-200 tilfælde per 100.000 indbyggere årligt, hvoraf 20-30 % er børn og unge. Trods BCG-vaccination af nyfødte samt en ihærdig indsats med hensyn til kontaktopsporing, behandlings-kontrol, forebyggelse og smitteopsporing har incidensen været vedvarende høj i de seneste 10 år.

Formål: at undersøge, hvordan forekomsten af TB blandt børn og unge i Grønland havde udviklet sig fra 1988-92 og til 2002-06. Videre at sammenligne TB incidensen blandt grønlændere med inuitbefolk-ningerne i Alaska og Canada med særligt fokus på territoriet Nunavut, hvor den største andel af canadiske inuit bor. Endelig var det formålet at belyse om de TB-ramte børn og unge adskilte sig fra andre på tilsvarende alderstrin, set i relation til social baggrund og levevilkår, samt endelig at opgøre dækningen af BCG.

Materiale og metode: Anmeldelser af TB tilfælde fra 1988-92 og fra 2002-06 blev sammenlignet. Registerdata fra Alaska og Canada blev sammenholdt med data fra Grønland til belysning af forekomsten af TB blandt inuit. Data fra et case-control studie foretaget i perioden fra 1.marts 2004 til 28.februar 2007 bestående af anmeldeskemaer, spørgeskemaer til belysning af sociale forhold og levevilkår samt oplysning om BCG-vaccination fra journaler blev analyseret.

Resultater og konklusion: TB incidensen var fra 1988-92 til 2002-06 steget fra 67 til 141 tilfælde pr. 100.000/år. Størst stigning sås blandt børn og unge, idet den forholdsmæssige andel af 0-19 årige steg med 6 %. En stigende andel af TB tilfælde i byerne syntes snarere at være forårsaget af flytning fra bygd til by i de hårdest ramte distrikter end et ændret smittemønster. Inuit i de undersøgte arktiske regioner har stærkt forhøjet TB incidens i forhold til den øvrige befolkning, og incidensen var højest i Grønland. Andelen af TB syge i alderen 0-19 årige var i Grønland 27 %, kun overgået af Nunavut (33 %). De vanskelige levevilkår er fælles for inuit i Nunavut og Grønland, men årsagerne til smittespredning er komplekse. Resultaterne af case-control studiet var pga. den lille population ikke statistisk signifikante, men tyder på en sammenhæng mellem levevilkår og TB, såsom højt antal beboere pr. m² og rygning, som også fundet af andre. Studiet indikerer en beskyttende effekt af BCG hos mindre børn (<10 år). Mange smittede og syge børn er et tegn på aktiv smittespredning, og de smittede børn vil være kilde til fremtidens TB. Der derfor god grund til at følge udviklingen blandt børn og unge nøje, samt at igangsætte initiativer for at bremse fortsat smittespredning.

Abstract [en]

Introduction: Tuberculosis is still a disease to be taken seriously in Greenland. The occurrence is high with 150-200 cases yearly per 100,000 inhabitants, 20-30 % of these are children and young people. The latest 10 years the incidents have been high continuously, in spite of BCG-vaccination of new-borns, and a persistent effort as regards contact tracing, control of treatment, preventive interventions, and tracking sources of infection.

Objective: To examine how the occurrence of TB among children and young people in Greenland has developed from 1988-92 and up till 2002-06. Further to compare the TB incidence among Greenlanders to that among Inuit populations in Alaska and Canada, with special focus on the territory of Nunavut, where the largest share of Canadian Inuit live. Furthermore, it was the intention to examine whether the TB-infected children and young people differed from the population in general at the same age level, in relation to social background and living-conditions, and finally to estimate the coverage of BCG.

Material and method: Notifications of TB-cases from l988-92 and from 2002-06 were compared. Register data from Alaska and Canada were related to data from Greenland to illustrate the occurrence of TB among Inuit people. Data from a case-control carried out in the period from March 2004 to February 2007 were analysed, consisting of notification forms, questionnaires regarding social conditions and living-conditions, plus information about BCG from case records.

Results and conclusion: The TB-incidence from 1988-92 to 2002-06 increased from 67 to 141 incidents per l00,000. The largest increase was seen among children and young people, as the relative share of 0-19 yearers increased by 6 %. An increasing share of TB incidents in the towns seemed more likely to have been caused by migration from settlement to town in the districts most affected, rather than by a changed pattern of infection. In the arctic regions examined, Inuit people have a strongly increased TB-incidence compared to the remaining population, and the incidence was highest in Greenland. In Greenland 27 % of TB patients were at the age of 0-19 years, and only surpassed by Nunavut (33 %). Difficult living-conditions are common for Inuit in Nunavut and in Greenland, but the causes of the spread of infection are complex. Because of the small population involved, the results of the case-control study were not statistically significant, but they indicate a correlation between living-conditions and TB, such as crowding and smoking, as also found by others. The study indicates a protective effect of BCG on small children (< 10 years). Occurrence of many infected and ill children indicates active spreading of the disease, and the infected children will be the source of TB of the future. Therefore, it is advisable to follow the development among children and young people closely, and to launch initiatives to prevent further dissemination of infection.

Place, publisher, year, edition, pages
2008. , 59 p.
Series
Master of Public Health, MPH, ISSN 1104-5701 ; MPH 2008:5
Keyword [en]
Tuberculosis, Child, Youth, Young People, Arctic, Public Health, Prevention
Keyword [da]
Tuberkulose, børn, unge, Grønland, arktis, folkesundhed
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3195OAI: oai:DiVA.org:norden-3195DiVA: diva2:724714
Presentation
2008-03-07, Nordic School of Public Health NHV, Box 12133, 402 42 Göteborg, Sweden, 11:41 (Danish)
Supervisors
Note

ISBN 978-91-85721-41-2

Available from: 2014-06-13 Created: 2014-06-13 Last updated: 2014-07-08Bibliographically approved

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