Wardani Dyah Wsr, Lazuardi Lutfan, Mahendradhata Yodi, Kusnanto Hari
Department of Public Health, Faculty of Medicine, University of Lampung, Jl. S. Brojonegoro No. 1 Bandar Lampung, Indonesia.
Department of Public Health, Faculty of Medicine, Gadjah Mada University, Jl. Farmako Sekip Utara Yogyakarta, Indonesia.
WHO South East Asia J Public Health. 2014 Apr-Jun;3(2):179-185. doi: 10.4103/2224-3151.206734.
The incidence of tuberculosis (TB) in the city of Bandar Lampung, Indonesia, increased during the period 2009-2011, although the cure rate for TB cases treated under the directly observed treatment, short course (DOTS) strategy in the city has been maintained at more than 85%. Cluster analysis is recognized as an interactive tool that can be used to identify the significance of spatially grouping sites of TB incidence. This study aimed to identify space-time clusters of TB during January to July 2012 in Bandar Lampung, and assess whether clustering co-occurred with locations of high population density and poverty.
Medical records were obtained of smear-positive TB patients who were receiving treatment at DOTS facilities, located at 27 primary health centres and one hospital, during the period January to July 2012. Data on home addresses from all cases were geocoded into latitude and longitude coordinates, using global positioning system (GPS) tools. The coordinate data were then analysed using SaTScan.
Two significant clusters were identified with P value of 0.05 for the primary cluster and 0.1 for the secondary cluster. Clusters occurred in areas with high population density and a high proportion of poor families and poor housing conditions. The short radius of the clusters also indicated the possibility of local transmission of TB.
The incidence of TB in Bandar Lampung was not randomly distributed, but significantly concentrated in two clusters. Identification of clusters of TB, together with its etiological factors such as social determinants, and risk factors, can be used to support TB control programmes, particularly those aiming to reach vulnerable populations, and intensified case-finding.
印度尼西亚楠榜市的结核病发病率在2009 - 2011年期间有所上升，尽管该市采用直接观察短程治疗（DOTS）策略治疗的结核病病例治愈率一直保持在85%以上。聚类分析被认为是一种交互式工具，可用于确定结核病发病地点空间分组的意义。本研究旨在确定2012年1月至7月楠榜市结核病的时空聚集情况，并评估聚集是否与高人口密度和贫困地区同时出现。
获取了2012年1月至7月期间在27个初级卫生中心和一家医院的DOTS设施接受治疗的涂片阳性结核病患者的病历。使用全球定位系统（GPS）工具将所有病例的家庭住址数据地理编码为经纬度坐标。然后使用SaTScan对坐标数据进行分析。
确定了两个显著聚集区，主聚集区的P值为0.05，次聚集区的P值为0.1。聚集区出现在人口密度高、贫困家庭比例高且住房条件差的地区。聚集区的短半径也表明了结核病存在局部传播的可能性。
楠榜市的结核病发病率并非随机分布，而是显著集中在两个聚集区。确定结核病聚集区及其社会决定因素和危险因素等病因学因素，可用于支持结核病控制项目，特别是那些旨在覆盖弱势群体的项目以及强化病例发现工作。
