Armed conflict in Colombia significantly impacts tuberculosis incidence and mortality rates

The prolonged armed conflict in Colombia has had a significant impact on tuberculosis (TB) incidence and mortality. This is revealed by a study led by the Barcelona Institute for Global Health (ISGlobal), a center supported by the "la Caixa" Foundation, which aimed to develop a municipal-level armed conflict intensity index and analyze how it relates to inequalities in the tuberculosis burden. 

The research, published in BMJ Global Health, analyzed data from 1,122 Colombian municipalities between 2008 and 2019. The research team combined information on different types of violence, such as kidnappings, forced displacement, disappearances, or armed attacks, with epidemiological surveillance data and mortality records. Conflict information was obtained from the National Observatory of Historical Memory, while TB morbidity and mortality data came from the National Public Health Surveillance System. Using these indicators, the team developed an index classifying municipalities according to conflict intensity in two periods: 2008–2013 and 2014–2019.

Unequal distribution of tuberculosis burden 

The study shows that TB incidence varied according to the level of conflict in each territory. Throughout the analyzed period, municipalities with the highest levels of violence recorded the highest TB case rates. Although at the national level TB case notifications decreased by 16% over the study period, the reduction was not uniform, and significant territorial inequalities persisted. Regarding mortality, results indicate that despite a 9% reduction nationwide, municipalities most affected by conflict continued to show the highest TB death rates.

Our findings show how armed conflicts can indirectly affect health. Displacement and forced migration create living conditions characterized by overcrowding, poor ventilation, and housing instability, which facilitate TB transmission and disease progression. These processes interact with conditions that compromise immune function, such as food insecurity, malnutrition, HIV infection, and other comorbidities, contributing to adverse TB outcomes."

Salomé Valencia, predoctoral researcher at ISGlobal and lead author of the study

Differences between population groups

The research also calculated tuberculosis rates by age and sex, finding significant differences among population groups. Children under one year showed the greatest inequalities: in municipalities with the highest conflict intensity, the likelihood of tuberculosis in this population group was 39 % higher than in those with lower conflict. Women also experienced persistent inequalities in case notifications. 

"Conflicts disproportionately affect women, children, and historically marginalized populations. Among these, indigenous communities face some of the most severe barriers. For example, on Colombia's Pacific coast, TB case notifications among indigenous groups reached 192.1 per 100,000 inhabitants, mainly related to limited access to healthcare services due to geographic isolation and conflict-related disruptions," points out Alberto Garcia-Basteiro, research professor at ISGlobal and senior author of the study.

Prevention strategies adapted to each territory

According to the research team, the observed inequalities in TB burden highlight the need to implement control strategies adapted to the characteristics of each territory. In particular, they emphasize the importance of incorporating conflict-sensitive approaches within surveillance, prevention, and healthcare systems to reduce inequities and strengthen public health response.

The research also proposes an analytical framework that can be applied to other conflict contexts to analyze health inequalities. This approach could help develop evidence-based policies to reduce the impact of prolonged conflicts on infectious diseases. 

The study involved researchers in epidemiology and public health, including Carlos Andrés Castañeda, Juan Camilo Gutiérrez, and Karol Cotes, from the National Institute of Health and the National University of Colombia in Bogotá.