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. 2018 Nov 26;13(11):e0207552.
doi: 10.1371/journal.pone.0207552. eCollection 2018.

Seasonal patterns of tuberculosis case notification in the tropics of Africa: A six-year trend analysis in Ethiopia

Z Gashu  1 , D Jerene  1 , D G Datiko  1 , N Hiruy  1 , S Negash  1 , K Melkieneh  1 , D Bekele  2 , G Nigussie  3 , P G Suarez  4 , A Hadgu  1
Affiliations

Seasonal patterns of tuberculosis case notification in the tropics of Africa: A six-year trend analysis in Ethiopia

Z Gashu et al. PLoS One. .

Abstract

Objective: Seasonal variations affect the health system's functioning, including tuberculosis (TB) services, but there is little evidence about seasonal variations in TB case notification in tropical countries, including Ethiopia. This study sought to fill this gap in knowledge using TB data reported from 10 zones, 5 each from Amhara and Oromia regions.

Methods: Notified TB cases for 2010-2016 were analyzed using SPSS version 20. We calculated the quarterly and annual average TB case notification rates and the proportion of seasonal amplitudes. We applied Winters' multiplicative method of exponential smoothing to break down the original time series into seasonal, trend, and irregular components and to build a suitable model for forecasting.

Results: A total of 205,575 TB cases were identified (47.8% from Amhara, 52.2% from Oromia), with a male-to-female ratio of 1.2:1. The means of 8,200 (24%), 7,992 (23%), 8,849 (26%), and 9,222 (27%) TB cases were reported during July-September, October-December, January-March, and April-June, respectively. The seasonal component of our model indicated a peak in April-June and a trough in October-December. The seasonal amplitude in Amhara region is 10% greater than that of Oromia (p < 0.05).

Conclusions: TB is shown to be a seasonal disease in Ethiopia, with a peak in quarter four and a low in quarter two of the fiscal year. The peak TB case notification rate corresponds with the end of the dry season in the two agrarian regions of Ethiopia. TB prevention and control interventions, such as efforts to increase community TB awareness about TB transmission and contact tracing, should consider seasonal variation. Regional variations in TB seasonality may require consideration of geographic-specific TB case-finding strategies. The mechanisms underlying the seasonal variation of TB are complex, and further study is needed.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Seasonal trends of TB case notified from agrarian regions of Ethiopia, July 2010-June 2016.
Months: Jul = July; Sep = September; Oct = October; Jan = January; Mar = March; Apr = April; Jun = June.
Fig 2
Fig 2. A sequence chart for original series and trend, seasonal, and irregular components,2010–2016.
Quarters: Q1 is the first quarter (July-September); Q2 is the second quarter (October-December); Q3 is the third quarter (January-March) and Q4 is the fourth quarter (April-June) A. the original quarterly time series; B. is the decomposed time series into the trend cycle; C. is a seasonal trend; and D. is an irregular components.
Fig 3
Fig 3. PAF of the quarterly notified TB cases from 2010–2016 with a peak at a lag of 3.
ACF: autocorrelation function; PAF: Partial autocorrelation function.
Fig 4
Fig 4. A seasonal time series TB case notification and forecast of Amhara, Oromia and the total.
See this image and copyright information in PMC

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