High infection rates of tuberculosis among aboriginal groups in Montreal

"Forgotten" disease disproportionately affects First Nations, and Inuit communities

Tuberculosis (TB), considered by many Canadians to be a forgotten disease, is alive and well in high-risk aboriginal communities in Montreal. According to the work of researchers at McGill University, the prevalence of latent TB infection among this group is high, nearly 18 per cent as compared to 4.3 per cent in the rest of the population. Their results will be published in the journal Qualitative Health Research.

Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air.

"While tuberculosis has been nearly eradicated in the non-aboriginal population in Canada, high rates of infection persist among some aboriginal people, especially those who are vulnerable, marginalized and as a result have poor access to health care," says Mary Ellen Macdonald, a professor of Oral Health and Society in the Faculty of Dentistry.

Working with the Native Friendship Centre, a community-based organization for aboriginal peoples in Montreal, Macdonald's McGill team lead by Dr. Paul Brassard, of the Division of Clinical Epidemiology of the Faculty of Medicine and with Dr. Kevin Schwartzman, Montreal Chest Institute, Faculty of Medicine; and Dr. Dick Menzies, Director, Respiratory Epidemiology Unit, McGill University Health Centre, and Faculty of Medicine performed TB skin tests on a sample of 141 people. A survey was also conducted to measure knowledge and attitudes of the disease among this group. One-on-one interviews were conducted with additional clientele from the Friendship Centre to better understand their experiences living with tuberculosis or having a loved one who had TB. Appropriate follow-up and medical treatment for those found with TB was planned.

Overall, the research showed a high prevalence of latent TB infection, at 17.7%. "Interestingly, in this at-risk population, individuals possessed a greater than average knowledge of the disease based on their own personal experiences and the past occurrences of TB in their native communities," said Macdonald who also is a medical anthropologist. "But because of the colonial history, which included isolating Inuit and First Nations TB patients in sanatoriums sometimes for years, a lot of fear surrounding treatment persists."

The team's research showed that there are major hurdles in access to first-line medical care in Montreal. The majority of the participants who reacted to the tuberculin skin test did not follow up on their scheduled medical evaluation. "In many cases, when we attempted to get these individuals medical help, we were not able to. A major barrier to getting them medical evaluation was simply that they did not have health cards."

Currently, Macdonald and Brassard are working with the Native Friendship Centre to determine how the community can best use these findings to improve the health of its members, and to explore other urgent primary health needs.

The research was funded by the Canadian Institutes of Health Research.