{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T10:04:28Z","timestamp":1764669868387,"version":"3.46.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We compared tuberculosis (TB) characteristics and outcomes between Syrian refugees and local citizens in Mardin, Turkey (2016\u20132023), a border province with substantial population mobility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective, registry-based cross-sectional analysis of 491 patients (locals\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f456; refugees\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f35). Descriptive comparisons used\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \/Fisher (categorical) and Mann\u2013Whitney 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;\n                      <jats:italic>p<\/jats:italic>\n                      -values from penalized likelihood-ratio (PLR) tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      BCG-scar positivity was lower in refugees than locals (62.9% vs. 93.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Microbiological confirmation remained below WHO targets in both groups. Crude treatment success was lower in refugees (68.6%) than locals (90.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.03), while transferred-out was higher (25.7% vs. 5.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001). In adjusted Firth models including all cases, refugee status was associated with lower odds of success (aOR 0.224, 95% CI 0.103\u20130.488; PLR\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001); after excluding transferred-out cases the association attenuated and was not significant (aOR 0.562, 95% CI 0.121\u20132.605; PLR\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.42). In pulmonary-only analyses, the association persisted (aOR 0.216, 95% CI 0.083\u20130.567; PLR\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002). Refugee incidence dipped in 2020\u20132021 and rebounded in 2022\u20132023.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Differences likely reflect operational barriers\u2014especially transfers disrupting continuity\u2014rather 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1729829","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T06:30:12Z","timestamp":1764225012000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Syrian civil war and assessment of tuberculosis among Syrian refugees and local citizens in Mardin"],"prefix":"10.3389","volume":"13","author":[{"given":"Bar\u0131\u015f","family":"\u00c7il","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet","family":"Kabak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet Sinan","family":"Bodur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erkan","family":"Sanmak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00fcldan","family":"G\u00fcne\u015f","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuf","family":"Alaka\u015f","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolai","family":"Savaskan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamdiye","family":"Turan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamza","family":"Oktay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"year":"2023","key":"ref1","article-title":"T\u00fcrkiye\u2019deki Suriyeli Say\u0131s\u0131 Haziran 2023"},{"volume-title":"World migration report 2018","year":"2017","author":"McAuliffe","key":"ref2"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1016\/S1473-3099(23)00372-9","article-title":"Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews","volume":"23","author":"Litvinjenko","year":"2023","journal-title":"Lancet Infect Dis"},{"volume-title":"Innovative solutions for the elimination of tuberculosis among refugees and migrants","year":"2024","author":"Kasaeva","key":"ref4"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e1007014","DOI":"10.1371\/journal.ppat.1007014","article-title":"Tuberculosis, war, and refugees: spotlight on the Syrian humanitarian crisis","volume":"14","author":"Ismail","year":"2018","journal-title":"PLoS Pathog"},{"key":"ref6","unstructured":"T\u00fcrkiye\u2019de Verem Sava\u015f\u0131 2017 Raporu\n          \n          \n          Ankara\n          T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131\n          \n          2017"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2001","DOI":"10.1007\/s10096-024-04918-4","article-title":"Impact of the COVID-19 pandemic and migration on tuberculosis notifications: a retrospective analysis with 5-year data from three centers","volume":"43","author":"Turan","year":"2024","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2101786","DOI":"10.1183\/13993003.01786-2021","article-title":"Gauging the impact of the COVID-19 pandemic on tuberculosis services: a global study","volume":"58","author":"Migliori","year":"2021","journal-title":"Eur Respir J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"330","DOI":"10.5505\/ejm.2019.49368","article-title":"The retrospective evaluation of tuberculosis cases in Mardin between 2012 and 2018","volume":"24","author":"Kabak","year":"2019","journal-title":"Eastern J Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"489","DOI":"10.5152\/TurkThoracJ.2021.21158","article-title":"The effect of environmental exposures on the diagnosis of tuberculosis in Syrian refugees","volume":"22","author":"Kurtulu\u015f","year":"2021","journal-title":"Turk Thorac J"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.cmi.2019.06.022","article-title":"Profiling infectious diseases in Turkey after the influx of 3.5 million Syrian refugees","volume":"26","author":"Erg\u00f6n\u00fcl","year":"2020","journal-title":"Clin Microbiol Infect"},{"year":"","key":"ref12","article-title":"Words matter language guide"},{"year":"","key":"ref13","article-title":"Adres Kay\u0131t Sistemi (AKS)"},{"year":"","key":"ref14","article-title":"Temporary protection \u2013 statistics"},{"year":"2016","key":"ref15","article-title":"Turkey: Syrian Refugee Camps Provincial Breakdown"},{"key":"ref16","first-page":"47","article-title":"BCG vaccination: where are we now?","volume":"52","author":"Yavuz","year":"2004","journal-title":"Tuberk Toraks"},{"year":"","key":"ref17","article-title":"Immunization and vaccine-preventable communicable diseases"},{"volume-title":"Global Tuberculosis Report 2022","year":"2022","key":"ref18"},{"year":"","key":"ref19","article-title":"Bacillus Calmette\u2013Gu\u00e9rin (BCG) vaccination coverage"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"100143","DOI":"10.1016\/j.jctube.2020.100143","article-title":"Migration and tuberculosis in Europe","volume":"18","author":"Boudville","year":"2020","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"year":"","key":"ref21","article-title":"T\u00fcberk\u00fcloz Rehberleri"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"457","DOI":"10.3201\/eid2503.180572","article-title":"Epidemiology of Extrapulmonary tuberculosis among inpatients, China, 2008\u20132017","volume":"25","author":"Pang","year":"2019","journal-title":"Emerg Infect Dis"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"443","DOI":"10.4103\/lungindia.lungindia_165_22","article-title":"Diagnostic yield of CBNAAT in the diagnosis of extrapulmonary tuberculosis: a prospective observational study","volume":"39","author":"Nishal","year":"2022","journal-title":"Lung India"},{"year":"2019","key":"ref24","article-title":"Global tuberculosis report 2019. Geneva: World Health Organization (WHO)"},{"volume-title":"Global tuberculosis report 2020","year":"2020","key":"ref25"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1186\/s12879-021-05828-y","article-title":"Tuberculosis (TB) in the refugee camps in Ethiopia: trends of case notification, profile, and treatment outcomes, 2014 to 2017","volume":"21","author":"Legesse","year":"2021","journal-title":"BMC Infect Dis"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s12916-016-0595-5","article-title":"The impact of migration on tuberculosis epidemiology and control in high-income countries: a review","volume":"14","author":"Pareek","year":"2016","journal-title":"BMC Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e0268696","DOI":"10.1371\/journal.pone.0268696","article-title":"Tuberculosis among refugees and migrant populations: systematic review","volume":"17","author":"Meaza","year":"2022","journal-title":"PLoS One"},{"year":"2024","key":"ref29","article-title":"Title: WHO releases new report addressing TB among refugees and migrants"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"252","DOI":"10.33709\/ictimaiyat.1055490","article-title":"Adaptation and future expectations of Syrian refugees living in Mardin: comparison between 2014 and 2021","volume":"6","author":"Apak","year":"2022","journal-title":"\u0130\u00e7timaiyat"},{"volume-title":"\u2018We feel safe here\u2019: Historic Turkish tourist city opens its doors to Syrian quake survivors","year":"2023","key":"ref31"},{"volume-title":"Tuberculosis stigma and racism, colonialism, and migration: A rapid qualitative review","year":"2021","author":"Smith","key":"ref32"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"88","DOI":"10.4274\/ThoracResPract.2024.24079","article-title":"A research on healthcare professionals\u2019 stigma towards tuberculosis patients","volume":"26","author":"Bodur","year":"2025","journal-title":"Thorac Res Pract"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2965","DOI":"10.2147\/RMHP.S314777","article-title":"Tuberculosis in migrants is among the challenges of tuberculosis control in high-income countries","volume":"14","author":"Woldesemayat","year":"2021","journal-title":"Risk Manag Healthc Policy"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"478","DOI":"10.4103\/ijmy.ijmy_223_21","article-title":"The impact of the COVID-19 pandemic on tuberculosis services","volume":"10","author":"Palanca","year":"2021","journal-title":"Int J Mycobacteriol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1729829\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T10:02:06Z","timestamp":1764669726000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1729829\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":35,"alternative-id":["10.3389\/fpubh.2025.1729829"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1729829","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2025,11,27]]},"article-number":"1729829"}}