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ANTC61H3 Chapter Notes -Mycobacterium Tuberculosis, First Nations, Basic Reproduction Number

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Week 9 Article 1
The association of housing density, isolation, and tuberculosis in Canadian First Nations Communities
-Early 20th century; death rate from T.B. in first nations in Canada was 700/100 000
Due to malnutrition, confinement on crowded reservations with poor sanitation, & lack of
immunity to the TB bacillus
-In 1999, rate was 10 times that of the overall Canadian rate in 1997
-Association has been recognized between overcrowded housing and T.B. incidence, paediatric TB, & TB
-T.B. incidence higher in communities which are isolated from health services
-All forms of T.B. were included; pulmonary & extrapulmonary
-Housing density expressed as the average number or persons per room (ppr) in a community, and
household income is expressed in Canadian dollars
Average housing density higher in first nations (F.N.) (0.7 ppr), than in non-aboriginal Canadian
population (0.4 ppr)
T.B. incidence rises as ppr increases
F.N. TB rates highest in Saskatchewan, then Alberta and Manitoba
The 3 provinces have highest average levels of housing density
Income levels lowest in maritime provinces
Manitoba has highest proportion of communities that are considered isolated (55.6%)
Ppr and income levels were higher in isolated communities
Analyses also showed that ppr and average household income not significantly related, though
community population and ppr were related
-Tb incidence is higher in communities located in isolated areas, and in communities with a higher
average housing density
-An increase in community income is associated with decreased risk of T.B.
Income levels are higher in isolated communities (where TB incidence is higher), this is because
there employees have higher wages since the cost of living is elevated.
-Some communities with overcrowded housing may experience a higher prevalence of latent TB
infection, and risk factors for progression from TB infection to disease
Risk factors: substance abuse, and under nutrition (more prevalent in communities with
socioeconomic disadvantages). Socioeconomic variables include unemployment & homelessness
-Overall, data supports the conclusion that overcrowded living conditions and isolation from health
services are associated with an increased risk of developing TB
-It has been hypothesized that severity of the TB epidemic among first nations was due more to social
conditions like crowding than the introduction of a more virulent strain of TB.
First nations likely experience an elevated risk of transmission, risk that may be related to
housing conditions. Overcrowded housing & inadequate community infrastructure have been
associated with increased risk for other infectious diseases like Shigellosis
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