EPIDEMIOLOGICAL FEATURES OF TUBERCULOSIS IN THE REGION OF PRIZREN

Aim: The aim of our research was to analyse the epidemiological features of tuberculosis in the Prizren region, its trend, and compare its incidence at the national level. In this study, data from the Institute of Public Health in Prizren and tuberculosis disease registration forms were utilized. The data were processed and analysed using descriptive epidemiological methods. Microsoft Excel 2016 was used for the analysis of results and presentation in tables and graphs. During the period from 2018 to 2022, 340 cases of tuberculosis were recorded in the Prizren region. Of these, 59% were male and 41% were female. The highest number of recorded cases was in 2019, with the municipality of Prizren being the most affected at the regional level. The age group most affected by TB during this period was 15-24 years old with 76 cases, followed by 72 cases in the age group /+/65 years, and 67 cases in the 25-34 age group. Pulmonary tuberculosis was recorded in the majority of cases, while extrapulmonary tuberculosis was noted in fewer cases. New cases predominated at over 90%, while recurrences occurred in 10% of cases. The average incidence of tuberculosis in the Prizren region for the period 2018-2022 was 31.9 per 100,000 inhabitants, while at the national level it was about 34.4 per 100,000 inhabitants. The incidence of tuberculosis showed an increasing trend in the Prizren region as well as at the national level. Adolescents and young adults are the most affected. This needs further investigation, and institutions should be more active in preventing and treating tuberculosis. Research Implications: The practical and theoretical implications of this research are discussed, providing insights into how the results can be applied or influence practices in the field of [Public health & Epidemiology]. These implications could encompass Public health sector in Prizren region. Originality/Value: This study contributes to the literature by emphasizing the originality of the research, either through the scientific epidemiological approach, the discovery of the epidemiological features of Tuberculosis in this region or practical contributions. The importance and value of this research is evidenced by the emphasis on the epidemiological features of tuberculosis and the practice of prevention and treatment of this disease.

Originalidad/Valor: Este estudio contribuye a la literatura al enfatizar la originalidad de la investigación, ya sea a través del enfoque epidemiológico científico, el descubrimiento de las características epidemiológicas de la tuberculosis en esta región o contribuciones prácticas.La importancia y el valor de esta investigación se evidencian por el énfasis en las características epidemiológicas de la tuberculosis y la práctica de la prevención y el tratamiento de esta enfermedad.

INTRODUCTION
Tuberculosis has been present throughout human history and remains the most common infectious disease in the world today (I.Dedushaj, 2005).In 2022, tuberculosis was the second leading cause of death after coronavirus disease (COVID-19), causing nearly twice as many deaths as HIV/AIDS.Every year, more than 10 million people worldwide fall ill (WHO, 2003).
In 2022, 7.5 million people were newly diagnosed with TB globally.This represents a 28% increase compared to the previous year (Fig. 1).In the European region, which includes Kosovo, there was a declining trend in TB in 2022 compared to previous years.
Tuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis.TB is widespread globally, but the highest incidence is in low-and middle-income countries, particularly in Sub-Saharan Africa, South Asia, and some parts of Latin America.
Kosovo is located in the southwestern part of Europe.It has about 1.8 million inhabitants (ASK, 2011) and is considered the poorest country in Europe, with a poverty rate of 21.9% or about 455,000 citizens (Mehmeti, 2012).Among the most prevalent diseases in the country is tuberculosis.The economic and social aspects of the country favor the development of this disease.

Kosovo map
Tuberculosis in Kosovo is present at a higher percentage compared to neighbouring countries.In 2022, the incidence of TB in Kosovo was higher than in EU countries (which have an average value of 10/100,000 inhabitants).Health professionals in the country are challenged by new TB cases despite efforts to control the disease, but the socio-economic situation and contemporary social development performance favour the appearance of this disease (F.Kryeziu et al., 2009).
Kosovo is part of a global project to combat tuberculosis, but the socio-economic situation and contemporary social development performance favour the appearance of this disease.Prizren represents one of the regions of the country with a population of approximately 386,628 inhabitants, with only one general hospital and only 8 pulmonologists/physiologists.Tuberculosis challenges this region, which is also burdened with other diseases such as COVID-19, Brucellosis, Tularemia, Hemorrhagic fevers, etc.
The aim of our research was to analyse the epidemiological parameters of tuberculosis in the Prizren region, its performance, and compare it with the incidence data at the national level.

MATERIAL AND METHODS
Data were obtained from disease registration and reporting forms, the tuberculosis registration form at the National Institute of Public Health in Prizren, annual reports on new and relapse cases, etc.
The data were analysed using descriptive epidemiological methods.All reports for all diagnosed tuberculosis cases were collected.
Each diagnosed case of tuberculosis was analysed by municipality of the region, gender, age, site of manifestation, whether it was a relapse or a new case, incidence of tuberculosis by year, etc.The incidence of tuberculosis in our region was compared with the incidence at the national level and in Balkan countries.Additionally, the incidence for cases in 2022 was determined by age and gender (Table 3).
The obtained results were presented in tables and graphs using Microsoft Excel (2016).

RESULTS AND DISCUSSIONS
Kosovo has a population of 1,773,971, while the Prizren region has 345,342 inhabitants.
The highest number of inhabitants are concentrated in the Municipality of Prizren with 193,806 inhabitants (ASK, 2023).During the period 2018-2022, 2,813 cases of tuberculosis were registered and reported at the national level, or about 32.3 cases per 100,000 inhabitants.In 2022 alone, 615 new cases of TB were reported, with an incidence of 34.4 per 100,000 inhabitants (Fig. 2).

Reported and registered TB cases in Kosovo 2018-2022
As seen from the figure above (Fig. 2), the TB trend curve in the country is fluctuating, with its rises and falls.This trend is almost the same as the global trend, where an increase was observed in 2022.The declining trend during 2020 and 2021 appears to be a consequence of the COVID-19 pandemic, which complicated the reporting and registration of cases, respectively pushing it to second place (Fig. 3).The highest number of cases is reported from the municipality of Prizren, with 178 cases or 52.35% of all cases in this region.This is expected as it is the largest municipality in the region, accounting for 56% of its population.However, the TB trend follows the population numbers of municipalities (see Fig. 3).
The highest number of cases is reported from the municipality of Prizren, with 178 cases or 52.35% of all cases in this region.This is expected as it is the largest municipality in the region, accounting for 56% of its population.However, the TB trend follows the population numbers of municipalities (see Fig. 3).Active tuberculosis in this period of our research appeared more in men with 202 cases or 59.4%, than in women where there were 138 cases or 41%.This condition occurs almost equally for each year separately (Fig ).TB by gender at the region of Prizren ('18-'22) Data on the incidence of tuberculosis in the country from 2018 to 2022 are presented graphically in Figure 5.According to these results, the incidence per 100,000 inhabitants varies from year to year, but compared to the incidence at the country level, it is lower.Thus, in 2022 the incidence at the country level is 34.4/100,000, and it is the highest in the Western Balkans (Figure 6) (NIPHK, 2023) 9 and developing countries.This trend is also affected by the appearance of cases resistant to tuberculostatics (MDR TB), which makes treatment and recovery difficult.

Figure 6
Global trend in case notifications of people

DISCUSSION
Tuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis.These bacteria usually attack the lungs but can also affect other parts of the body such as the kidneys, spine and brain.TB is one of the oldest known human diseases and continues to be a major health problem in many parts of the world, but especially in our country (Dedushaj, 1997).
This disease (TB) requires a multidisciplinary approach, while the epidemiological service is only one link of its surveillance (Kryeziu, 2022).Kosovo is part of a partnership to fight TB.In 2022, the number of reported cases was 615 or with Mb 34.4/100000p, while in the Prizren region it resulted in 31.8 per 100000 inhabitants (IKSHPK, 2023).
The highest incidence of tuberculosis in our survey was in 2019, while at the national level in 2018.However, last year (2022) an increasing trend of tuberculosis was observed in the Prizren region, but also at the country level.The increasing trend of TB has been reported by the WHO, especially in developed countries, because of emerging resistance to anti-TB drugs (WHO, 2003).
Our findings, compared to reports from other countries, are inconsistent in terms of age.
For example, while in our study the most affected age group is 15-24 years, followed by 25- 10 comorbidities, etc.But it remains to be further investigated the stimulus of the age of 16-34 years, which is under close antitubercular protection.In our country, about 50% of the population is under 30 years old (ASK, 2011), so it seems that this parameter affects the occurrence of the highest incidence in the age group of 15-24 years, or perhaps the antitubercular vaccination has been compromised during the years of the dominance of COVID 19 in Kosovo.

CONCLUSION
Tuberculosis is still a public health problem in the Prizren region.
The incidence of tuberculosis has shown an increasing trend.The affected age of teenagers and young people is a very specific problem, due to the risks that accompany this age from the misuse of various substances, drugs, alcohol, lack of perspective, malnutrition, etc.
The number of medical professionals is small and is not distributed in all municipalities according to the number of inhabitants.There is little or no local activity of our partnership with the Global Fund in implementing the 'Stop TB' strategy and the Millennium Development Goals in this region of the country.
The Public Health of the Prizren region, but also at the national level, should urgently take steps towards the establishment of tuberculosis control, and the same disease should remain on the priority list of health institutions.
Build a multidisciplinary approach to tuberculosis, including family doctors, pulmonologists, epidemiologists, microbiologists, social workers, etc.
The patronage service must be activated and strengthened.
Partnership activities with the Global Fund should be distributed at the level of regions of the country.
In addition to the economic and social well-being of the community, to build efficient supervision and control of the TB service.
Investigate cases of MDR-TB (drug-resistant tuberculosis) and consider them in the TB control process.
To implement the strategies designed for the prevention and control of TB.
Joining international organizations, including the World Health Organization and other donors, to be as large and important as possible for the financing and implementation of various interventions.
In general, we can conclude that Kosovo has made progress in the control and treatment of tuberculosis, but challenges remain, especially in relation to drug resistance and the impacts of the COVID-19 pandemic.
Continued efforts and sustained support are needed to improve the situation and further reduce the burden of tuberculosis in the country.Future research should focus on identifying the specific factors contributing to the higher incidence of TB among adolescents and young adults in the Prizren region.Additionally, exploring the impact of socio-economic conditions on TB incidence and implementing strategies to address these factors can further enhance TB control efforts.

Figure 2 TB
Figure2TB cases compared with no. of inhabitants according to municipalities of the PrizrenRegion,   2018Region,    -2022

TB cases compared to the number of inhabitants by municipality
The age most affected by TB during this period is the age of 15-24 years with 76 cases or 22.3%, followed by 72 cases of the age /+/65 years or 21.7%, as well as 25-34 with 67 cases or 19.7%.The inclusion of ages 15-34, with a total of 143 cases or 42% of all cases, shows that we are dealing with the most sensitive age, young age and in the productive phase.This represents a challenge for health institutions in the country, especially for public health.This epidemiological feature is not in line with the trend in developed countries where old age dominates (/+/65 years).According to the last census in 2011, over 50% of the population is under the age of 30.The least affected age was 0-14 years.In the region of Prizren, as well as at the country level, vaccination against tuberculosis is carried out, building immune protection against tuberculosis.This vaccination and the low level of involvement of the 0-14 year old speaks for the success of this process.The high rate affected by TB is age > 64+ with 72 cases or 21%, following the trend of tuberculosis in developing countries (Table2): Nr. Banorëve Rastet me TB % Epidemiological Features of Tuberculosis in the Region of Prizren ___________________________________________________________________________ Rev. Gest.Soc.Ambient.|Miami | v.18.n.8 | p.1-12 | e08332 | 2024.7