Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
BMJ Glob Health. 2022 Feb;7(2). doi: 10.1136/bmjgh-2021-007599.
HIV, tuberculosis (TB) and malaria are the three most important infectious diseases in Ethiopia, and sub-Saharan Africa. Understanding the spatial codistribution of these diseases is critical for designing geographically targeted and integrated disease control programmes. This study investigated the spatial overlap and drivers of HIV, TB and malaria prevalence in Ethiopia.
HIV, TB and malaria data were obtained from different nationwide prevalence surveys, and geospatial covariates were obtained from publicly available sources. A Bayesian model-based geostatistical framework was applied to each survey leveraging the strength of high-resolution spatial covariates to predict continuous disease-specific prevalence surfaces and their codistribution.
The national prevalence was 1.54% (95% CI 1.40 to 1.70) for HIV, 0.39% (95% CI 0.34 to 0.45) for TB and 1.1% (95%CI 0.95 to 1.32) for malaria. Substantial subnational variation was predicted with the highest HIV prevalence estimated in Gambela (4.52%), Addis Ababa (3.52%) and Dire Dawa (2.67%) regions. TB prevalence was highest in Dire Dawa (0.96%) and Gambela (0.88%), while malaria was highest in Gambela (6.1%) and Benishangul-Gumuz (3.8%). Spatial overlap of their prevalence was observed in some parts of the country, mainly Gambela region. Spatial distribution of the diseases was significantly associated with healthcare access, demographic, and climatic factors.
The national distribution of HIV, TB and malaria was highly focal in Ethiopia, with substantial variation at subnational and local levels. Spatial distribution of the diseases was significantly associated with healthcare access, demographic and climatic factors. Spatial overlap of HIV, TB and malaria prevalence was observed in some parts of the country. Integrated control programmes for these diseases should be targeted to these areas with high levels of co-endemicity.
艾滋病毒、结核病（TB）和疟疾是埃塞俄比亚和撒哈拉以南非洲地区三种最重要的传染病。了解这些疾病的空间共存情况对于设计具有地域针对性和综合性的疾病控制规划至关重要。本研究调查了埃塞俄比亚艾滋病毒、结核病和疟疾流行的空间重叠和驱动因素。
从不同的全国性流行情况调查中获取艾滋病毒、结核病和疟疾的数据，并从公开来源获取地理空间协变量。针对每个调查，应用基于贝叶斯模型的地统计学框架，利用高分辨率空间协变量的优势，预测连续的疾病特异性流行率曲面及其共存情况。
艾滋病毒的全国流行率为 1.54%（95%CI 1.40-1.70），结核病为 0.39%（95%CI 0.34-0.45），疟疾为 1.1%（95%CI 0.95-1.32）。预测出了显著的次国家级差异，最高的艾滋病毒流行率估计在甘贝拉（4.52%）、亚的斯亚贝巴（3.52%）和德雷达瓦（2.67%）地区。结核病的流行率在德雷达瓦（0.96%）和甘贝拉（0.88%）最高，而疟疾在甘贝拉（6.1%）和本尚古勒-古马兹（3.8%）最高。在该国的一些地区，观察到这些疾病的流行率存在空间重叠，主要是在甘贝拉地区。这些疾病的空间分布与医疗保健可及性、人口和气候因素显著相关。
在埃塞俄比亚，艾滋病毒、结核病和疟疾的全国分布高度集中，在次国家级和地方级存在很大差异。这些疾病的空间分布与医疗保健可及性、人口和气候因素显著相关。在该国的一些地区观察到艾滋病毒、结核病和疟疾流行率的空间重叠。这些疾病的综合控制规划应针对这些高共发性地区。
