Wolde Haileab Fekadu, Clements Archie C A, Alene Kefyalew Addis
School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.
Geospatial and Tuberculosis Research Team, The Kids Research Institute, Nedlands, Western Australia, Australia.
Int J Epidemiol. 2025 Aug 18;54(5). doi: 10.1093/ije/dyaf157.
Country-level estimates can mask local geographic variations in progress toward achieving World Health Organization's End TB targets. This study aimed to identify spatial variations in progress toward achieving the TB incidence reduction target at a district level in Ethiopia.
A Bayesian linear regression model with a conditional autoregressive prior structure was developed to identify drivers of spatial variations in TB incidence reduction across districts and to identify spatial patterns and variations in TB incidence reduction across Ethiopia from 2015 to 2020.
The national average TB incidence reduction was 31%. Ten out of 14 regions achieved a reduction of >20% in TB incidence. Out of 641 districts, 395 (61.6%) met the 20% reduction target, predominantly in the Oromia, Amhara, and South Ethiopia regions. Spatial clustering of decreased incidence reduction was noted in the Afar, Benishangul-Gumuz, and Somali regions. Factors associated with the percentage reduction in TB incidence include a 1% increase in the proportion of individuals with good TB knowledge [β: 4.23%; 95% credible interval (CrI): 1.6, 6.9], a 1-unit increase in the TB service readiness index (β: 3.41%; 95% CrI: 0.89, 6.1), and a 1-km increase in the distance from the international border (β: 2.63%; 95% CrI: 0.02, 5.10).
Geographic disparities in TB incidence reduction persist in Ethiopia, with only some districts achieving the national reduction targets. Targeted interventions, such as improving TB service readiness and enhancing awareness through education, are crucial to addressing these gaps, particularly in regions such as Afar, Benishangul-Gumuz, and Somali.
国家层面的估计可能掩盖在实现世界卫生组织终止结核病目标方面的局部地理差异。本研究旨在确定埃塞俄比亚各地区在实现结核病发病率降低目标方面的空间差异。
建立了具有条件自回归先验结构的贝叶斯线性回归模型，以确定各地区结核病发病率降低的空间差异驱动因素，并确定2015年至2020年埃塞俄比亚全国结核病发病率降低的空间模式和差异。
全国结核病发病率平均降低了31%。14个地区中有10个地区的结核病发病率降低超过了20%。在641个地区中，395个（61.6%）达到了20%的降低目标，主要集中在奥罗米亚、阿姆哈拉和埃塞俄比亚南部地区。在阿法尔、本尚古勒-古穆兹和索马里地区发现了发病率降低减少的空间聚集现象。与结核病发病率降低百分比相关的因素包括结核病知识良好的个体比例增加1%[β：4.23%；95%可信区间（CrI）：1.6，6.9]、结核病服务准备指数增加1个单位（β：3.
