Tuberculosis notifications, characteristics and treatment outcomes: urban vs. rural Solomon Islands, 2000-2011

Setting: All provincial tuberculosis (TB) management units in the Solomon Islands. Objective: To compare TB notifications, characteristics and treatment outcomes in urban vs. rural areas. Design: A retrospective descriptive cohort study involving record review and data extraction from provincial TB and laboratory registers and treatment charts from 2000 to 2011. Results: Of 4137 TB cases notified, 1364 (33%) were from urban and 3227 (67%) from rural areas. Notification rates per year of study were consistently higher in urban areas (104-150 per 100 000 population) than in rural areas (49-70/100 000). Cases in rural areas were more likely to have smear-negative pulmonary TB and less likely to have extra-pulmonary TB (P < 0.001). TB cases in rural areas were more likely to die from TB than those from urban areas (3.2% vs. 5.9%). In contrast, TB cases in rural areas were less likely to default (2.8% vs. 1.8%). Conclusion: TB notification rates were much higher in urban than in rural areas in the Solomon Islands. Rural patients are more likely to die from the disease but are slightly less likely to default. Further research is required to explore the possibility of under-reporting in rural areas and to improve treatment outcomes.