Tuberculosis among Tibetan refugees in India.

Tuberculosis (TB) is a major public health problem among Tibetan refugees in India. To determine the incidence of and risk factors for TB among Tibetan refugees in India, data on TB were included in the demographic and health surveillance project carried out by the Tibetan government-in-exile in Dharamsala from 1994 to 1996. Risk factor and morbidity data were determined by baseline and monthly follow-up home visits, and reported TB was confirmed by clinic records. The surveillance covered ~90% of the refugees in civilian settlements and ~70% of the monks in monasteries. In the settlement population, TB incidence was extraordinarily high in the settlement population, 10.9/1000 in 1994, but decreased to 7.7/1000 in 1996. Incidence rates varied between regions, age groups, and occupational groups, being highest in the Doon Valley (14.8/1000), in sweater sellers (16.7/1000), and in the unemployed (23/1000). Among monastery monks, incidence rates were even higher than in the settlements, averaging 17.2/1000 over the 3-year period. The proportion of patients without sputum results and variation in the proportion of smear positive cases indicated inadequate use and poor quality of laboratory services. India's Revised National Tuberculosis Control Program, based on WHO-recommendations, has been highly successful in pilot districts and is being extended to the whole country. This program should be adopted promptly by the health care system serving Tibetan refugees and vigorously implemented among the refugee population.