A statistical–retrospective study of pulmonary tuberculosis in Iraqi Kurdistan Governorates

. Pulmonary tuberculosis (PTB) is still a global problem and serious epidemic disease and leads to a high death rate especially in developing countries, partially due to problematic ecological situation. The aim of this study to verifying the numbers and percentages of individuals infected with PTB in Iraqi Kurdistan Governorates 2019. A statistical–retrospective study was carried out to investigate the numbers and percentages of individuals infected with PTB in three provinces in Iraqi Kurdistan; Erbil, Sulaymaniyah and Duhok from the 1st January to 31st December 2019. All essential details of annual data for PTB patients were obtained from the National Center of PTB in Baghdad Governorate, Iraq. A total of 639 cases were recorded in 2019; 295 male (46.1%) and 344 female (53.9%). Erbil Governorate had the highest number of infections with 302 cases (47.2%) followed by Sulaymaniyah and Duhok with 214 (33.5%) and 123 (19.3%) respectively, the most cases were recorded in 2nd quarter with 170 cases (26.6%). The highest frequency of PTB was recorded in age groups 65–80 with 123 cases (19.2%) while the lowest was 5–14 with 20 cases (3.1%). Pulmonary TB remains a threat in Iraqi Kurdistan and about half of cases have been recorded in Erbil Governorate. The highest frequency of PTB was in females than males and the older age groups were the most infected. Therefore, we need more precautionary measures to control this disease.


Introduction
Pulmonary TB is a serious and deadly illness mainly caused by Gram-Positive bacterium Mycobacterium tuberculosis (Mtb) that mainly affects the lungs and is spread from person to person, mostly by coughing [1,2].In spite of all attempts to prevent the spread of this infection, is still persists in many continents especially in Asia and Africa [3].While there were multiple treatment strategies to manage PTB, it is still the ninth leading cause of death in the world; it is a chronic disease mostly affecting the lower socioeconomic classes of society [4].Many factors lead to the spread of PTB in the population, such as lack of health Corresponding author: ahmedaj.aljanabi@uokufa.edu.iq* E3S Web of Conferences 381, 01100 (2023) https://doi.org/10.1051/e3sconf/202338101100AQUACULTURE 2022 awareness, malnutrition, wasting, impaired immunity, diabetes mellitus and lack of continued exposure to sunlight [5,6].Globally, about 10.000.000people are infected with PTB each year and the number seems to be stable [7].For PTB control programs to be successful, people who come in contact with infected patients must be investigated [8].Despite this practice being well-accepted in low-incidence countries, it is extremely uncommon in high incidence ones since many developing nations focus mostly on the treatment of active PTB cases [9].The incidence rate of PTB in Iraq ranks 7th out of 15 countries in WHO-Eastern Mediterranean with 42 cases per 100,000 individuals [10].Iraqi Kurdistan has been using Directly Observed Treatment Short Courses since 2001, but he seems to have not completely eliminated the PTB, and this may be due to the instability in the province [11].The epidemiological study of PTB is considered one of the most important studies in population societies to know the extent of the spread of this deadly disease and how to control it to prevent it and maintain a population free of this disease because it threatens public safety [12].There are thousands of tourists visiting Iraqi Kurdistan every year, making it one of the most popular tourist governorates in the country.Therefore, the aim of this study to verifying the numbers and percentages of individuals infected with PTB and comparing it with the previous studies before 2019 to investigate if there was any development in PTB treatment in the province.

Study design
A statistical-retrospective study was carried out to investigate the numbers and percentages of individuals infected with PTB in three Governorates in Iraqi Kurdistan; Erbil, Sulaymaniyah and Duhok from the 1st January to 31st December 2019.All essential details of annual data for PTB patients were obtained from the National Center of PTB in Baghdad Governorate, Iraq.The seasonal infections have been divided into four quarters as follows; the first quarter includes January, February; and March, the second quarter includes April, May and June, the third quarter includes July, August and September and the fourth quarter includes October, November and December [13,14,15].

Statistical analysis
SPSS version 10 software has been used.Numbers and percentages were used to compare individuals infected with PTB according to age groups, genders and quarters [16,17,18].

3rd quarter
One hundred and fifty cases have been recorded ( M: Male, F: Female, Total (%): total numbers and percentage of PTB patients.

Discussion
It is very necessary to study the spread of diseases in populations, especially those that are transmitted between individuals quickly and dangerously, causing an epidemic that may be difficult to treat [19].Therefore, we aimed in this epidemiological study to record the numbers and percentages of individuals infected with PTB in three important tourist Governorates in Iraqi Kurdistan in 2019.Our findings documented that there was high PTB incidence with 639; 259 male and 344 female and the most cases were in quarter two.Among the governorates, Erbil ranked first with 302 cases.Previous epidemiological studies conducted on the prevalence of PTB in Iraq indicated that there were high numbers of the population who are infected every year in different Governorates [2,20].A study in Duhok Governorate that proved a prevalence of PTB was 12% in 2019 [21].Balaky et al.
[22] found there were 728 PTB case in Erbil Governorate during the period from 2012 to 2017.Report in 2016 by Karadakhy et al. [23] reported that there were a total of 530 new and relapsed cases, or an annual incidence of 31 per 100,000 in the Sulaimaniyah Governorate during 2010.More than 73% of cases were pulmonary PTB, and 45% of patients overall had positive smear results.The three most prevalent symptoms were fever (49%) and perspiration (58%) [7].Nearly 43% of patients had direct swab examinations, 30% had biopsies, and 23% had clinical and radiologic examinations to determine their diagnoses.In terms of result, 89% of patients received a successful treatment, 7% passed away, and 3% defaulted.A Brief Report by Hussein et al. [24] in Kurdistan Region of Iraq found that 62/150 (41.3%) of the participants were positive.33/62 (53%) of the respondents who answered positively were men.It is crucial to identify PTB among close contacts, as reactivation of such infections is the leading cause of TB cases and identifying potential risk factors for PTB is a key to reducing PTB incidence [25,26].The bulk of PTB cases originate from reactivation of such illnesses and rapid dissemination throughout communities, especially in populous tourist governorates, making it imperative policy to identify PTB among close contacts and identify potential risk factors of getting the infection [27,28].

Conclusions
Pulmonary TB remains a threat in Iraqi Kurdistan and about half of cases have been recorded in Erbil Governorate.The highest frequency of PTB was in females than males and the older age groups were the most infected.Therefore, we need more precautionary measures to control this disease.

Fig. 1 .
Fig. 1.Mycobacterium tuberculosis cells isolated from the sputum of a 45-year-old male stained with acid-fast stain (by authors).Magnification power 1000X.

Table 1 .
Table 2 shows the highest number of cases in the Erbil Governorate: 302 (74.2%) followed by AL-Sulaymaniyah 214 cases (33.5%), while Duhok recorded the lowest number of infections with 123 cases (19.3%).The highest frequency of PTB was recorded in age groups 65-80 with 123 cases (19.2%) followed by age group 25-34 with 103 cases (16.2%), while the lowest was among children 5-14 years with 20 cases (3.1%).Total numbers and percentages of PTB patients in Iraqi Kurdistan Governorates in 2019.
Total (%): total numbers and percentage of PTB patients.

Table 2 .
Total numbers and percentages of PTB patients in three Iraqi Kurdistan Governorates in 2019.

Table 3 .
Numbers and percentages of PTB patients in Iraqi Kurdistan Governorates in 1stquarter 2019.

Table 4 .
Numbers and percentages of PTB patients in Iraqi Kurdistan Governorates in 2nd quarter 2019.

Table 5 .
Numbers and percentages of PTB patients in Iraqi Kurdistan Governorates in 3rdquarter 2019.

Table .
Numbers and percentages of PTB patients in Iraqi Kurdistan Governorates in 4thquarter 2019.