Reducing the burden of tuberculosis in the Māori, the Indigenous people of New Zealand

Elevated tuberculosis rates among Indigenous peoples are a major theme in the history of worldwide tuberculosis. This trend is seen in the Māori, the Indigenous people of New Zealand.1Institute of Environmental Science and ResearchTuberculosis in New Zealand annual report 2016.https://surv.esr.cri.nz/PDF_surveillance/AnnTBReports/TBannualreport2016.pdfDate: 2019Date accessed: April 24, 2019Google Scholar Despite New Zealand being a country with a low tuberculosis burden, the disease has a disproportionally high incidence in Māori communities (six times higher) compared with New Zealanders of European descent, according to New Zealand's 2016 annual report on tuberculosis1Institute of Environmental Science and ResearchTuberculosis in New Zealand annual report 2016.https://surv.esr.cri.nz/PDF_surveillance/AnnTBReports/TBannualreport2016.pdfDate: 2019Date accessed: April 24, 2019Google Scholar and personal communication with Liza Lopez, a senior analyst at the New Zealand Institute of Environmental Science and Research. It is widely believed that tuberculosis (mate kohi in the Māori language) arrived in New Zealand with European settlement. In the late 19th and early 20th century, both Māori and Europeans reported high incidence of the disease. In the mid-20th century, reports of tuberculosis incidence declined substantially because of the mass introduction of x-ray technology, BCG vaccination, anti-tuberculosis drugs, public education, and improvements in living standards. In the past decade, reports of tuberculosis incidence in New Zealanders of European descent have been consistently low at 1·0 (SD 0·3) cases per 100 000. Despite a decline in tuberculosis over the past ten years, to date the Māori still have a significantly higher incidence of the disease at 6·3 (2·1) cases per 100 000 (figure). Maxime Cormier and colleagues2Cormier M Schwartzman K N'Diaye DS et al.Proximate determinants of tuberculosis in Indigenous peoples worldwide: a systematic review.Lancet Glob Health. 2019; 7: e68-e80Summary Full Text Full Text PDF PubMed Scopus (22) Google Scholar described that factors affecting the disparity in tuberculosis incidence among Indigenous peoples worldwide include social and cultural differences, access to health care, food security, diabetes, smoking, and prevalence of alcohol use. The causes of the recognised disparity between Māori and non-Māori in the tuberculosis burden of New Zealand is confounded by scarce research on the characteristics of the disease in the Māori population. In addition, Mycobacterium tuberculosis strains circulating among the Māori are specific to New Zealand and have been established throughout the past 30 years.3De Zoysa R Shoemack P Vaughan R Vaughan A A prolonged outbreak of tuberculosis in the North Island.New Zealand Public Health Rep. 2001; 8: 1-3Google Scholar, 4Mulholland CV Ruthe A Cursons RT et al.Rapid molecular diagnosis of the Mycobacterium tuberculosis Rangipo strain responsible for the largest recurring TB cluster in New Zealand.Diagn Microbiol Infect Dis. 2017; 88: 138-140Crossref PubMed Scopus (7) Google Scholar A comprehensive analysis of these strains is still insufficient. Cromier and colleagues2Cormier M Schwartzman K N'Diaye DS et al.Proximate determinants of tuberculosis in Indigenous peoples worldwide: a systematic review.Lancet Glob Health. 2019; 7: e68-e80Summary Full Text Full Text PDF PubMed Scopus (22) Google Scholar show the need for community-led, culturally appropriate strategies to address tuberculosis. Further research on the transmissibility and characteristics of these strains needs the direct involvement of Māori communities in its conception and design. This collaboration will help researchers to better understand the cultural and social factors responsible for the differential tuberculosis incidence in Māori and non-Māori people. Modern medicine and technology, coupled with kaupapa Māori (any community plan of action created by Māori, done with Māori participation, and aimed at Māori) that incorporates both Māori culture (Māoritanga) and Māori health values (tikanga), are essential to assist in forming meaningful interventions and reduce tuberculosis disease inequalities in New Zealand. In this way, the ultimate goal of eradicating tuberculosis in the Indigenous people of New Zealand and WHO's End Tuberculosis Strategy will be achieved. We declare no competing interests. Proximate determinants of tuberculosis in Indigenous peoples worldwide: a systematic reviewIndigenous peoples were generally reported to have a higher prevalence of several proximate determinants of tuberculosis than non-Indigenous peoples, with wide variation across Indigenous communities. These findings emphasise the need for community-led, culturally appropriate strategies to address smoking, food insecurity, and diabetes in Indigenous populations as important public health goals in their own right, and also to reduce the burden of tuberculosis. Full-Text PDF Open Access