Tuberculosis

A Culturally-Relevant Perspective on This Issue

Introduction

Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (TB bacilli) [1].  TB infects the lungs and the symptoms include coughing, sometimes with sputum or blood, chest pains, fever, night sweats, weight loss and weakness. Healthy people infected with TB bacilli generally do not present symptoms, since their immune system kills the TB bacilli, or the bacilli becomes dormant. When a person’s immune system weakens, dormant TB bacilli can turn into active TB disease [1]. Though TB is easily prevented by vaccine, it is very prevalent in Aboriginal populations in Canada, and is 17 times higher among some Aboriginal groups compared to the Canadian population [2].

There are several reasons used to explain the high TB rate among the Aboriginal population including a large number of TB infected people living in Aboriginal communities; poor socioeconomic conditions, such as overcrowded housing [3]; and limited access to health care services in remote areas [3]. Though TB is widespread among Aboriginal people, there remains a lack of information regarding the disease, particularly among the Métis population. Also, given that TB is a common co-infection of HIV, systematic reporting of HIV status among TB cases is needed to improve the prevention and control of TB in Canada, including among Aboriginal peoples [4].

First Nations

The rate of tuberculosis among First Nations people has been decreasing over the past decade, however is still extremely high in comparison to the Canadian population. In 2000, the TB rate in First Nations population was nearly six times that of the general population with 34 cases/100,000 population in First Nations people compared to 6 cases/100,000 in the general Canadian population[5].

Métis

TB data for the Métis population has only been recently collected, limiting the data available. The TB rate among the Métis population is relatively low, and has remained constant over the past couple of years [4]. Data from 2004 shows the total number of TB cases among the Métis to be 6. The incidence rate (the number of newly diagnosed cases) for TB among the Métis population was 2, compared to 5 in the general population. This rate was much lower compared to the incidence rate in Canadian born Aboriginals which was 24 [4].

Inuit

Inuit communities in Canada have the highest incidence rate of TB of any group in the country [6]. In 2006, five percent of Inuit adults had been diagnosed with tuberculosis [7]. The Inuit region of Nunavut has the highest prevalence of tuberculosis (6%), and Nunavik has the lowest (3%) prevalence of all Inuit regions. The TB rate in Nunavut is currently 17 times the Canadian rate [5]. There is speculation around the reasons behind the high TB rates among the Inuit people. Some possible reasons include crowded housing, malnutrition, lack of immunity to the mycobacterium bacillus and restricted access and delivery of health care services in rural and remote areas [8, 4].

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