School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Faculty of Medicine, Department of Microbiology, Unit for Genome Dynamics, University of Oslo, Oslo, Norway.
PLoS One. 2021 Jan 15;16(1):e0245378. doi: 10.1371/journal.pone.0245378. eCollection 2021.
Tuberculosis (TB) remains a key health menace in Ethiopia and its districts. This study aimed to assess the spatial-temporal clustering of notified pulmonary TB (PTB) cases in East Gojjam Zone, Northwest Ethiopia.
A retrospective study was conducted among all PTB cases reported from 2013-2019. Case notification rates (CNRs) of PTB cases at Kebele (the lowest administrative unit), woreda, and zone levels were estimated. The PTB clustering was done using global Moran's I statistics on Arc GIS 10.6. We used Kulldorff SaTScan 9.6 with a discrete Poisson model to identify statistically significant spatial-temporal clustering of PTB cases at Kebele level. Similarly, a negative binomial regression analysis was used to identify factors associated with the incidence of PTB cases at kebele level.
A total of 5340 (52%) smear-positive and 4928 (48%) smear-negative PTB cases were analyzed. The overall mean CNR of PTB cases at zone, woreda and Kebele levels were 58(47-69), 82(56-204), and 69(36-347) per 100,000 population, respectively. The purely spatial cluster analysis identified eight most likely clusters (one for overall and one per year for seven reporting years) and 47 secondary clusters. Similarly, the space-time scan analysis identified one most likely and seven secondary clusters. The purely temporal analysis also detected one most likely cluster from 2013-2015. Rural residence, distance from the nearest health facility, and poor TB service readiness were factors (p-value <0.05) to PTB incidence at kebele level.
The distribution of PTB cases was clustered. The PTB CNR was low and showed a decreasing trend during the reporting periods. Rural residence, distance from the health facilities, and poor facility readiness were factors of PTB incidence. Improving accessibility and readiness of health facilities mainly to rural and hotspot areas is vital to increase case detection and reduce TB transmission.
结核病（TB）仍然是埃塞俄比亚及其地区的主要健康威胁。本研究旨在评估埃塞俄比亚东北贡德尔地区报告的肺结核（PTB）病例的时空聚集情况。
对 2013 年至 2019 年报告的所有 PTB 病例进行回顾性研究。估计了 Kebeles（最低行政单位）、 woreda 和 zone 各级别的 PTB 病例的病例报告率（CNR）。使用 ArcGIS 10.6 中的全局 Moran's I 统计量对 PTB 病例进行聚类分析。我们使用 Kulldorff SaTScan 9.6 中的离散泊松模型来识别 Kebeles 级别 PTB 病例的统计学显著时空聚类。同样，使用负二项回归分析来识别 Kebeles 级别与 PTB 病例发生相关的因素。
共分析了 5340 例（52%）涂片阳性和 4928 例（48%）涂片阴性的 PTB 病例。区、 woreda 和 Kebeles 各级别的 PTB 病例的总体平均 CNR 分别为 58（47-69）、82（56-204）和 69（36-347）/100,000 人口。纯空间聚类分析确定了 8 个最有可能的集群（一个为整体，一个为 7 个报告年中的每一年）和 47 个二级集群。同样，时空扫描分析确定了一个最有可能的集群和七个二级集群。纯时间分析也从 2013 年至 2015 年检测到一个最有可能的集群。农村居民、离最近卫生机构的距离和较差的结核病服务准备情况是 Kebeles 级别结核病发病率的因素（p 值<0.05）。
PTB 病例的分布呈聚集性。PTB 的 CNR 较低，在报告期间呈下降趋势。农村居民、离卫生机构的距离和较差的设施准备情况是结核病发病率的因素。改善卫生设施的可达性和准备情况对于提高病例检出率和降低结核病传播至关重要。
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