State Institution "Kundiiev Institute of Occupational Health of the National Academy of Medical Sciences of Ukraine", Kyiv
Introduction. Tuberculosis (TB) is a socially dangerous chronic human infectious disease. Occupational groups with high risk of infection with Mycobacterium tuberculosis include workers of treatment establishments, clinical (bacteriological and pathoanatomical) laboratories, ritual services, rescue services, law enforcement agencies and correctional bodies, social services, education, utilities, public administration, passenger transport, agriculture and forestry, hunters, zoo workers and veterinary service, extractive industry, migrant workers, public catering personnel, military personnel, and others.
The purpose of the study is to determine regularities of formation of occupational ТВ morbidity in working people in Ukraine in the dynamics of surveillance.
Materials and methods of research. A comparative analysis of the data for the period of 2013–2017 years has been made. The basis of the methodology for studying occupational morbidity was the principle of continuous statistical selection of primary documents, drawn up for all cases of the first identified occupational diseases and registered in Ukraine for the years indicated. The analysis was conducted by the types of economic activity, professions, age, work experience, etc. The data on cases of ТВ of occupational genesis among those working for the specified period were obtained under the Agreement on Cooperation with the Social Insurance Fund of Ukraine.
Results. In the last 5 years (2013–2017), there were recorded 280 cases of TB in Ukraine associated with occupational activity. Tuberculosis in the structure of occupational disease has a share of about 2 %. The main branches that make up the incidence of TB among those working in Ukraine are extraction of coal, medicine and social assistance. Also, single cases of TB are recorded in the production of steel and iron, refractory products, in the extraction of sand, gravel, clay and kaolin, and iron ores. The average age of men who have been infected with TB is 50 years, and the average length of experience is equal to 12 years. In women, the average age of patients is significantly lower – 43 years with the average work experience of 13 years. In considering the circumstances of establishing a diagnosis of TB related to working conditions in Ukraine in 2013–2017 (Table 6), it is evident that during the entire period under investigation, cases of occupational TB are more likely to be detected in referring workers to health care facilities than during periodic medical examinations, resulting in the diagnosis of the disease at later stages of development.
Conclusions. In Ukraine, in the period of 2013–2017, there is a decrease in cases of TB of occupational genesis from 111 to 32, with a decrease in the incidence rate from 0,6 to 0,2 per 100 thousand employees, which points to insufficient detection of cases of tuberculosis related to work conditions, and referring it to the general morbidity. The highest risk of development of occupational tuberculosis is observed in such branches as coal mining and health care, and social assistance, and in this, the rate of morbidity in them is much smaller than the rate of the general morbidity of TB in Ukraine. The cases of tuberculosis are found in many professions in coal mining; especially it concerns sinkers, miners and electric locksmiths in underground. There is also a wide range of occupations in which cases of TB are registered, e.g., in the field of health care and social assistance. Most often, junior and middle medical staff is ill. But in other professions of this sphere there is recorded quite a lot of cases: these are doctors of different specializations, auxiliary personnel, laboratory workers.
The prevalence of cases of TB related to working conditions are registered mostly when addressing patients to health care facilities than during periodic medical examinations, which can be a reason of diagnosis of this disease at later stages of development, causing complications in treatment and in prognosis for patients.
The reasons for this situation are, first of all, the professional lack of knowledge in the diagnosis of TB of physicians of medical commissions who have the right to conduct periodic medical examinations; secondly, the absence of specific complaints and pathological changes at the early stages of the disease development in an objective examination; and thirdly, doctors do not take into account an occupational history of patients.
Key words: tuberculosis, conyotuberculosis, occupational diseases, Ukraine
ORCID ID of co-authors and their contribution to the preparation and writing of the article:
Nagorna AM (ORCID ID 0000-0003-3311-7523) - the idea of research, analysis of individual provisions, generalized conclusions;
Sokolova MP (ORCID ID 0000-0001-9590-1407) - formation of tables, analysis of the results, writing of the article;
Kononova I.G. (ORCID ID 000-003-3483-9464) - collection and analysis of materials, statistical calculations.