Human Tuberculosis and its Risk Factors in Sudan

As is the case with citizens of other sub-Saharan countries, Sudanese suffer from various epidemic and communicable diseases. Tuberculosis is one of the leading causes of mortality of humans in developing countries (Corbett et al.

The incidence of human tuberculosis in Sudan was estimated at 108/100,000 population in 2013. This accounts for 15% of the TB burden in the World Health Organization’s Eastern Mediterranean Region (WHO 2014). The average preva­lence of zoonotic tuberculosis in African countries is estimated to be 2.8% of all tuberculosis cases (264/100,000 population/year); this translates into an estimated seven zoonotic human BTB cases/100,000 population/year in Sudan (Muller et al. 2013). In addition, HIV and mycobacterial drug resistance are some of the major drivers sustaining endemic tuberculosis in developing countries (Corbett et al. 2006; Wright et al. 2009).

In 2014, the prevalence of HIV in Sudan was estimated to be 0.2% (World Bank

2015). This is of some concern given that in the neighboring Tanzania, M. bovis was isolated from seven of 65 (10.8%) HIV-infected patients with cervical adenitis (Cleaveland et al. 2007; Mfinanga et al. 2004). Based on this observation, it is expected that HIV infections will exacerbate the number of zoonotic tuberculosis cases and that it will increase the difficulty of combating TB worldwide (Katale et al. 2012). This situation should be of great concern in Sudan given the lack of information about M. bovis, and particularly HIV/M. bovis co-infections in humans.

The close association between humans and their animals in rural areas in Sudan may also enhance the risk of them contracting zoonotic BTB. The common practice here of consuming uninspected meat from illegally slaughtered livestock and the lack of awareness of dairy workers about the risk of BTB are additional factors that increase the risk of becoming infected with M.

Wildlife reservoirs may also serve as a source of human infection at the human/ wildlife/livestock interface in large ecosystems (Ocepek et al. 2005). Trans­boundary nomadic movement can similarly contribute to the dissemination of the disease between domestic animals and wildlife that share pastures with livestock owned by the nomads.

In conclusion, it is imperative that a large-scale, population-based, surveillance program is launched to assess the actual prevalence of zoonotic TB in humans in Sudan. The high prevalence of BTB in cattle here supports the likelihood that the disease remains a major health risk for humans in Sudan. Therefore, proper meat inspection, regular health checks of the abattoir workers for occupational zoonotic tuberculosis, and the implementation of awareness-enhancing campaigns are impor­tant activities to consider when controlling BTB in Sudan.

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