Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Sheela Shenoi

Second Advisor

Kaveh Khoshnood


​​Tuberculosis (TB) is the second leading cause of death by an infectious disease worldwide after COVID-19. Extensive efforts have been made for decades to tackle this disease through bolstering healthcare systems especially in countries experiencing a disproportionate burden of TB. Ukraine is considered by the WHO to be one of the 30 high burden countries in the world with a notably high burden of MDR TB. In addition, Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia as well as the fifth largest number of extensive drug resistant cases in the world. Ukraine has made extensive progress in expanding Tuberculosis and HIV centered healthcare efforts in the past several decades improving the national incidence rates. On February 24, 2022 Russia invaded Ukraine leading to armed conflict especially along the Southeastern border. Armed conflict and war are well documented events that have the potential to disrupt healthcare delivery efforts and turn back the clock on progress made towards tackling diseases such as Tuberculosis. To evaluate the potential early impact of the war on the national Tuberculosis incidence, national aggregate data was obtained from the Center of Public Health of the Ministry of Health in Ukraine. The aim was to analyze trends in diagnostic testing and trends in positive results among people being evaluated for Tuberculosis in Ukraine before the war in 2021 and during the war in 2022 in order to infer the potential impact on healthcare delivery and services and thus national TB testing and incidence. Linear regression analysis was conducted on the total number of TB tests completed as well as the total number of positive TB test results, both of which exhibited a negative linear relationship from January 2021 to August 2022. In order to assess if the change in trends over time was significant, a Cochran-Armitage test for trend was applied utilizing R Studio for the total number of TB tests conducted from January to August for 2021 and 2022, rate of positive TB tests over time from January to August of 2021 and 2022, and the total number of TB tests conducted from January to August of 2021 and 2022. The test for trend applied to the total number of TB tests conducted and the total number of positive TB tests provided a p-value below 0.05 indicating that the null hypothesis of no trend over time could be rejected and the alternative hypothesis could be considered. The preliminary results of this data analysis point to a potential decreasing national incidence of Tuberculosis as well as decreasing Tuberculosis testing rates nationally. Data collection and analysis for areas impacted by armed conflict will experience several barriers to optimal performance, thus requiring cautious interpretation of the data. It is imperative to continue to engage in data collection in areas impacted by armed conflict and other humanitarian disasters in order to better understand how healthcare systems are performing and to thus inform how national and international efforts can be tailored to support delivery of healthcare services related to diseases such as Tuberculosis in ongoing humanitarian crises.


This is an Open Access Thesis.

Open Access

This Article is Open Access