Milaham Makplang, Van Gurp Margo, Adewusi Oluwafemi J, Okonuga Oluwaseun Chidera, Ormel Hermen, Tristan Bayly, Adejo Solomon, Yusuf Abdulrasheed, Gidado Mustapha
Institute of Human Virology, Abuja, Nigeria.
KIT Royal Tropical Institute, Amsterdam, Netherlands.
J Public Health Afr. 2022 Oct 20;13(3):2040. doi: 10.4081/jphia.2022.2040. eCollection 2022 Sep 7.
Tuberculosis (TB) is prevalent in Nigeria, and Katsina, along with other 12 states in the country, accounts for a high proportion of unnotified TB cases: constituting the high priority-intervention States in the country. Interventions focused on TB detection and coverage in the state could benefit from a better understanding of hotspot Local Government Areas (LGAs) that trigger and sustain the disease. Therefore, this study investigated the spatial distribution of TB Case Notification Rates (CNRs), diagnostics and coverage across the LGAs. Using 2017 to 2019 TB case finding data, the geocoordinates of diagnostic facilities and shapefiles, a retrospective ecological study was conducted. The data were analysed with QGIS and GeoDa. Moran's I and LISA were used to locate and quantify hotspots. The coverage of microscopy and GeneXpert facilities was assessed on QGIS using a 5 km and 20 km radius, respectively. The CNR in the state, and 29 of the 34 LGAs, increased steadily from 2017 to 2019. Hotspots of high CNRs were also identified in 2017 (Moran's I=0.106, p-value=0.090) and 2018 (Moran's I=-0.020, p-value=0.370). While CNRs increased along with presumptive TB rates across most LGAs over the years, the positivity yield and bacteriological and Xpert diagnostic rates decreased. Bacteriological and GeneXpert coverage were 78% and 49% respectively. Additionally, only 51% of the state's population lived within 20km of a GeneXpert facility. These results suggest that TB program interventions had some positive impact on the CNR, however, diagnostic facilities need to be equitably distributed and more innovative approaches need to be explored to find the missing cases.
结核病（TB）在尼日利亚很普遍，卡齐纳州与该国其他12个州一样，未报告的结核病病例占比很高：是该国高优先级干预州。聚焦于该州结核病检测和覆盖率的干预措施，可能会受益于对引发和持续传播该疾病的热点地方政府辖区（LGA）有更好的了解。因此，本研究调查了各地方政府辖区结核病病例报告率（CNR）、诊断情况和覆盖率的空间分布。利用2017年至2019年结核病病例发现数据、诊断设施的地理坐标和地理信息文件，开展了一项回顾性生态研究。数据用QGIS和GeoDa进行分析。莫兰指数（Moran's I）和局部空间自相关分析（LISA）用于定位和量化热点。分别使用半径5公里和20公里在QGIS上评估显微镜检查和基因检测设施的覆盖率。该州以及34个地方政府辖区中的29个，其病例报告率从2017年到2019年稳步上升。2017年（莫兰指数=0.106，p值=0.090）和2018年（莫兰指数=-0.020，p值=0.370）也确定了高病例报告率的热点地区。虽然这些年来大多数地方政府辖区的病例报告率随疑似结核病发病率上升，但阳性检出率以及细菌学和基因检测诊断率下降。细菌学和基因检测覆盖率分别为78%和49%。此外，该州只有51%的人口居住在距离基因检测设施20公里范围内。这些结果表明，结核病防治项目干预措施对病例报告率有一些积极影响，然而，诊断设施需要公平分布，并且需要探索更具创新性的方法来发现漏报病例。
