Acid-Fast Bacilli Smear Positivity and HBV, HCV, HIV, and Syphilis Co-infections between 2016 and 2019 in Mogadishu, Somalia

Although tuberculosis (TB) is a treatable disease, it continues to be an important health problem affecting societies worldwide. TB is one of the 10 most common causes of death worldwide today, despite the efforts of national organizations and the global struggle efforts of the World Health Organization (WHO), that have continued since its first establishment and exceeded seventy years. Somalia faces many negative factors that hinder the success of TB eradication programs, such as limitation of economic resources, lack of adequate infrastructure systems in the urban and rural regions, inadequacies in sheltering and nutrition, as well as instability, conflicts, and difficulties in accessing health care services. However, the country has been located in a rapidly developing region where socio-economic development and transformation has been experienced in many fields in recent years. This study includes the analysis of Acid Resistant Basil (ARB) smear examination results of patients admitted to a tertiary health center in the region where public health surveillance, screening programs, and treatment interventions have been disrupted for the last 30 years due to the aforementioned reasons. A total of 5,160 ARB test results of 3,909 patients admitted to the hospital with different medical reasons during the 4-year period between July 2016 and November 2019 were included in the study. The mean age was 43.3±21.8 years, with a range of <1 to 97 years and the ARB test positivity rate was found to be %5.63 (220/3,909) in the study group. The positivity rate was 6.70% (158/2,199) in males and 3.99% (62/1,490) in females (p<0.001). The group most affected by the infection (TB) were young and adult men between the ages of 10-40. HBsAg, anti-HCV and anti-HIV tests were also performed for approximately half of the patients who requested ARB test and the co-infection rates for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) were found as 9.68%, 2.46%, and 0.0%, respectively. These rates are compatible with the seroepidemiological situation of the mentioned viral infections in the region. The results also reveal the low frequency of HIV-TB co-infections in the Somali population, unlike other regions of sub-Saharan Africa. The co-infection rate for syphilis, in which fewer patients were tested, was found to be 2.27%. It was found that ARB positivity rates changed as 5.31%, 6.44%, and 5.63% between 2017-2019 and did not increase or decrease according to years; with the exception of 2016 (11.2%) when a small number of patients were admitted. Early diagnosis and early treatment of active cases are critical for the effectiveness of TB control programs. Despite certain limitations, the data presented in the study can be considered as a reference point for future studies.