Iqaluit (Mar 13/06) - Despite the 44 active cases of tuberculosis in Nunavut at the end of 2005 - 12 more than in 2004 - the department of health and social services says not to worry.

Communicable diseases consultant Elaine Randell says numbers fluctuate rapidly and it takes decades to see a real trend.

She says important statistics show the territory's TB program working. For example, according to the Canadian TB standards guide, the rate of TB patients relapsing should be no more than three per cent. Nunavut's relapse rate is one per cent. The guide's standard for drug resistance is the same, and Nunavut's rate of TB patients becoming immune to TB medication is also one per cent.

"This is an indication that our program is working," said Randell. "We're on the right track."

Randell attributes the success to the fact that every patient identified as having TB - whether it be at the infectious, active or dormant stage - must take their medication in front of a nurse. This makes sure they are taking the right dosage, and also that they have support if need be.

According to the most recent statistics, the rate of TB infection here is 17 times the national rate.

Randell says there are lots of factors leading to the Nunavut numbers.

"There is still a large pool of infection from the past, when the treatment wasn't as good as it is now. Also, people don't have the natural immunity," she said.

Nunavut's unique demographics also lend reason. "Half the population are under 25 and children have two to three times more of a risk of contacting TB and becoming infectious."

Also, the social issues like housing, nutrition and smoking are huge factors.

"Those are the factors we can work on and change, as opposed to natural immunity," she said.

Helle Moeller worked in Nunavut as a TB nurse from 1997 to 1999. Later, she worked for the GN as a TB consultant and her Lakehead University masters thesis is on the socio-cultural experience of TB in Nunavut.

She agrees with the causes but says the failings to ultimately help the situation lie in cultural differences. Moeller says Qallunaat make up the majority of the health care system and it's tough to tackle health threats with such cultural differences.

"However, and I believe more importantly, the history of colonization and continuing colonization play a significant role in the levels of health, disease, and TB in Nunavut," she says.

The new focus is education. The department is planning to distribute Nunavut-specific pamphlets and information to all health centres in the territory.

Moeller says this won't help.

"No research has shown that health education is a predictor for TB program success. Other research has, on the other hand, shown that positive change in health caregivers' attitudes towards clients significantly increased TB program success.

"In my opinion, for success individuals must feel comfortable turning to the health care system when they experience discomfort, must feel comfortable coming for a check-up although they do not feel sick but have been in contact with someone who is, must feel comfortable discussing their terms of treatment and allowing health-care personnel into their homes, and must feel that the people who care for them are part of their community."