In our study, it is seen TB infects more people. this stituation arise from non-blood people living together (communal living style) and refugees brought along with wars. While TC citizens live mostly in a nuclear family type, refugees live in a communal type. It is seen that the average living area(m2) per a contact refugee is reduced almost in half comparing to that of Turkish citizens.
In this study; it is determined that 98 of the participants (%50,5) were refugees, and 72 (%37,1) lived in a nuclear family. It was determined that 57 (%58,2) of the refugees have a communal life, where 47 (%49,0) of the TC citizens have a nuclear family type of living. The count of the contact scanning that was done among refugees resulted in being 549. İt determined total living area of 7740 m2, average living area per person being 14,09 m2. With the TC citizens; the scanned the count of the contact was 487, the total living area was 11370 m2 and the average living area per person was found to be 23,34 m2. The count of contacts that was started on a protective treatment was 247 with refugees while being 138 in count with TC citizens. In this study, a statistical significance has been found between different living styles -nuclear family type and communal living-. According to the total count of contact people, a statistical significance has been also detected among nuclear family, extended family, and the communal living style. Statistically significance, according to nationality type, the mean of living area per person among Turkish citizens was much higher than that of refugees, in our study. It has been found that there is a statistically significant positive correlation between the living area and the total the count of the contact.
On one hand, there are accomplishments achieved in the war with TB and strategies of ending it (1, 3, 4, 13, 22) on the other hand, threats to social life due to man-made wars still exist (23). Wars are an obstacle for the eradication of TB which has been a threat to peoples' lives for thousands of years. (3, 4, 24, 25, 26).
Family members who have contact with the patient, have the risk of infecting people as well as their co-workers (27, 28). Collective living area like schools, dormitories, barracks, and prisons( 1, 29 ); and communal family life are similar due to people without any blood relations living together. In tuberculosis guidelines, it has been shown that the refugee patients are in the high-risk group in terms of contacted examination and that procedures like diagnosis and treatment of tuberculosis are taking place (1, 13). The outcomes that we attained from our study support the guidelines in terms of the average living space per person and the living style of refugees being communal. Our study shows that the work environment of the refugees should be similarly taken into account with their home environment, as well. Balbay et al. in their study in which they looked into living conditions of tuberculosis patients, have determined that 80,6 % of patients share the same home with 1-4 other people and 68,9 percent of the patients live in properties that have 2 or 3 rooms (30). It has been detected that the refugees live with many more people in our study. Additionally, the people who share the living area with the refugees being non-blood related (communal living), is another new information for the literature. According to data of State İnstitute of Statistics of our country, the number of persons per room is 1,27 (31). For a serious amount of patients of our study, the number of people that are sharing the same house is between 5 and 6.
In some studies of the literature, although performing tuberculin skin test (TST) and chest radiography screenings -if needed- are suggested (32); the analysis of the cost-effectiveness of screening programs had concluded that current radiographic screening programs have a minimum effect and that they are not low-cost (33). In our study, patients with tuberculosis and their contacts have been scanned and proceeded with their treatment. Though, certainly, it is not a scanning procedure that could be done due to numbers that reach millions on the first arrival of refugees. Some studies suggest anonymous scanning systems regarding security concerns (34, 35). The latent tuberculosis infection scanning was done with tuberculin in our study. It is seen that in both TC citizens and refugees, the count of the contact examinations per patient has been increased (1). In a study done in tent camps for refugees, similar results have been established in terms of tuberculosis patients and contact persons between refugees and Turkish citizens (36). The vaccination degree is above 95 % in temporary shelters (37). As seen here, health service in refugee shelters could be considered sufficient. These services are even more limited for refugees living out of camp(38). As for this study, it has been seen that communal life certainly causes an increase in the number of contacted individuals but this rise is caused mostly by out of camp refugees rather than the ones living in tent cities. The refugee live in the tent camp generally and also they easily reach health services in spite of living in such a limited space like 16 m2. the our study results supported higher the count of the contact among refugees who living the communal life area who live out of tent camp.
On the other hand, the living areas of communal living people have been found significantly larger comparing to both nuclear families and the people who live in extended families. This result shows the ones who are in a communal lifestyle live in much larger places.
It is assumed that there are 244 million international immigrants worldwide in 2015, one-third of them being reported (39). In 2014, it is thought that 19.5 million refugees existed worldwide. Syrian refugees live mostly in Turkey (40). 3.6 million refugees are living safely in Turkey by the year 2019. In addition to that; undocumented immigrants and refugees are still a crucial problem and usually, there are serious obstacles in the way of getting needed health services (1, 13, 41). In our study, the undocumented tuberculosis patients and contact people have been reported to relevant departments for registration certificates, as well as being given the proper health examinations.