Syrian civil war and assessment of tuberculosis among Syrian refugees and local citizens in Mardin.

BACKGROUND

We compared tuberculosis (TB) characteristics and outcomes between Syrian refugees and local citizens in Mardin, Turkey (2016-2023), a border province with substantial population mobility.

METHODS

Retrospective, registry-based cross-sectional analysis of 491 patients (locals n = 456; refugees n = 35). Descriptive comparisons used χ 2/Fisher (categorical) and Mann-Whitney U (age). Annual incidence per 100,000 used mid-year denominators (locals: ABPRS/NVI; refugees: DGMM/PMM and UNHCR). For outcomes with significant crude differences (treatment success, BCG scar, transferred-out), age- and sex-adjusted bias-reduced (Firth) logistic regression was applied; p-values from penalized likelihood-ratio (PLR) tests.

RESULTS

BCG-scar positivity was lower in refugees than locals (62.9% vs. 93.2%, p < 0.001). Microbiological confirmation remained below WHO targets in both groups. Crude treatment success was lower in refugees (68.6%) than locals (90.4%, p = 0.03), while transferred-out was higher (25.7% vs. 5.3%, p = 0.001). In adjusted Firth models including all cases, refugee status was associated with lower odds of success (aOR 0.224, 95% CI 0.103-0.488; PLR p < 0.001); after excluding transferred-out cases the association attenuated and was not significant (aOR 0.562, 95% CI 0.121-2.605; PLR p = 0.42). In pulmonary-only analyses, the association persisted (aOR 0.216, 95% CI 0.083-0.567; PLR p = 0.002). Refugee incidence dipped in 2020-2021 and rebounded in 2022-2023.

CONCLUSION

Differences likely reflect operational barriers-especially transfers disrupting continuity-rather than intrinsic factors. Refugee-inclusive TB services with robust inter-provincial transfer tracking, patient navigation, and expanded bacteriological testing (notably for extrapulmonary disease) should be prioritized. Given the small refugee subgroup and denominator uncertainties, findings are hypothesis-generating.