Research Article: Spatial and space-time clustering of tuberculosis in Gurage Zone, Southern Ethiopia

Date Published: June 5, 2018

Publisher: Public Library of Science

Author(s): Sebsibe Tadesse, Fikre Enqueselassie, Seifu Hagos, Mohammad Ali.

http://doi.org/10.1371/journal.pone.0198353

Abstract

Spatial targeting is advocated as an effective method that contributes for achieving tuberculosis control in high-burden countries. However, there is a paucity of studies clarifying the spatial nature of the disease in these countries. This study aims to identify the location, size and risk of purely spatial and space-time clusters for high occurrence of tuberculosis in Gurage Zone, Southern Ethiopia during 2007 to 2016.

A total of 15,805 patient data that were retrieved from unit TB registers were included in the final analyses. The spatial and space-time cluster analyses were performed using the global Moran’s I, Getis-Ord Gi* and Kulldorff’s scan statistics.

Eleven purely spatial and three space-time clusters were detected (P <0.001).The clusters were concentrated in border areas of the Gurage Zone. There were considerable spatial variations in the risk of tuberculosis by year during the study period. This study showed that tuberculosis clusters were mainly concentrated at border areas of the Gurage Zone during the study period, suggesting that there has been sustained transmission of the disease within these locations. The findings may help intensify the implementation of tuberculosis control activities in these locations. Further study is warranted to explore the roles of various ecological factors on the observed spatial distribution of tuberculosis.

Partial Text

Ethiopia remains among high Tuberculosis (TB) endemic countries in the world, with an estimated annual incidence of 177 per 100,000 population [1]. TB places an extraordinary public health, financial and social burden in the country [2, 3]. It is one of the most important infectious diseases responsible as a leading cause of death and second cause of hospital admission [4, 5]. The patients face various levels of isolation and rejection, including loss of employment, reduced education opportunities, vulnerability to disability and divorce or spoiled marriage prospects [6]. Moreover, co-infection with Human Immunodeficiency Virus and the emergence of resistance to numerous anti-TB agents are recognized as increasing problems in the country [7, 1].

This study aims to identify the location, size and risk of purely spatial and space-time clusters for high occurrence of TB in Gurage Zone, Southern Ethiopia during 2007 to 2016. The clusters with high likelihood of TB occurrence were detected in border areas of the zone. The possible explanation for this could be that there were frequent cross-border population movements from the neighboring border areas of Jimma, Yem, Hadiya, Silte, West Shewa and East Shewa zones for economic and social reasons, which could favor the disease transmission in these areas. This is true according to other studies [24]. Therefore, future TB prevention and control efforts in these areas should include strengthening health infrastructure, staff capacity building, considering early diagnosis and treatment of symptomatic cases, and increasing community awareness. Furthermore, establishing a cross-border collaboration network may also help reduce the disease burden in these areas.

This study showed that TB clusters were mainly concentrated at border areas of the Gurage Zone, suggesting that there has been sustained transmission of the disease within these locations. The findings may help intensify the implementation of TB control activities in these locations. Further study is warranted to explore the roles of various ecological factors on the observed spatial distribution of TB.

 

Source:

http://doi.org/10.1371/journal.pone.0198353

 

0 0 vote
Article Rating
Subscribe
Notify of
guest
0 Comments
Inline Feedbacks
View all comments