Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal; Hospital Rural de Chicumbane, Limpopo, Mozambique.
Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal.
Spat Spatiotemporal Epidemiol. 2024 Feb;48:100632. doi: 10.1016/j.sste.2023.100632. Epub 2023 Dec 12.
Mozambique is a high-burden country for tuberculosis (TB). International studies show that TB is a disease that tends to cluster in specific regions, and different risk factors (HIV prevalence, migration, overcrowding, poverty, house condition, temperature, altitude, undernutrition, urbanization, and inadequate access to TB diagnosis and treatment) are reported in the literature to be associated with TB incidence. Although Mozambique has a higher burden of TB, the spatial distribution, and determinants of TB incidence at the sub-national level have not been studied yet for the whole country. Therefore, we aimed to analyze the spatial distribution and determinants of tuberculosis incidence across all 154 districts of Mozambique and identify the hotspot areas.
We conducted an ecological study with the district as our unit of analysis, where we included all cases of tuberculosis diagnosed in Mozambique between 2016 and 2020. We obtained the data from the Mozambique Ministry of Health and other publicly available open sources. The predictor variables were selected based on the literature review and data availability at the district level in Mozambique. The parameters were estimated through Bayesian hierarchical Poisson regression models using Markov Chain Monte Carlo simulation.
A total of 512 877 people were diagnosed with tuberculosis in Mozambique during our five-year study period. We found high variability in the spatial distribution of tuberculosis incidence across the country. Sixty-two districts out of 154 were identified as hotspot areas. The districts with the highest incidence rate were concentrated in the south and the country's central regions. In contrast, those with lower incidence rates were mainly in the north. In the multivariate analysis, we found that TB incidence was positively associated with the prevalence of HIV (RR: 1.23; 95 % CrI 1.13 to 1.34) and negatively associated with the annual average temperature (RR: 0.83; 95 % CrI 0.74 to 0.94).
The incidence of tuberculosis is unevenly distributed across the country. Lower average temperature and high HIV prevalence seem to increase TB incidence. Targeting interventions in higher-risk areas and strengthening collaboration between HIV and TB programs is paramount to ending tuberculosis in Mozambique, as established by the WHO's End TB strategy and the Sustainable Development Goals.
莫桑比克是结核病（TB）负担沉重的国家。国际研究表明，结核病是一种倾向于在特定区域聚集的疾病，不同的风险因素（HIV 流行率、迁移、过度拥挤、贫困、住房条件、温度、海拔、营养不良、城市化以及获得结核病诊断和治疗的机会不足）在文献中被报道与结核病发病率相关。尽管莫桑比克的结核病负担较高，但全国范围内还没有研究过次国家级别的结核病发病率的空间分布和决定因素。因此，我们旨在分析莫桑比克所有 154 个区的结核病发病率的空间分布和决定因素，并确定热点地区。
我们进行了一项以区为分析单位的生态研究，其中包括 2016 年至 2020 年间在莫桑比克诊断出的所有结核病病例。我们从莫桑比克卫生部和其他公开可用的开源数据中获取数据。预测变量是根据文献综述和莫桑比克区一级的数据可用性选择的。参数是通过贝叶斯分层泊松回归模型使用马尔可夫链蒙特卡罗模拟估计的。
在我们的五年研究期间，莫桑比克共有 512877 人被诊断患有结核病。我们发现该国结核病发病率的空间分布存在高度变异性。154 个区中有 62 个被确定为热点地区。发病率最高的区集中在南部和该国中部地区。相比之下，发病率较低的区主要在北部。在多变量分析中，我们发现结核病发病率与 HIV 流行率呈正相关（RR：1.23；95%CrI：1.13 至 1.34），与年平均温度呈负相关（RR：0.83；95%CrI：0.74 至 0.94）。
结核病发病率在全国范围内分布不均。较低的平均温度和较高的 HIV 流行率似乎会增加结核病发病率。针对高风险地区的干预措施以及加强艾滋病毒和结核病规划之间的合作，对于按照世界卫生组织的终结结核病战略和可持续发展目标终结莫桑比克的结核病至关重要。
