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. 2021 Jan 15;16(1):e0245378.
doi: 10.1371/journal.pone.0245378. eCollection 2021.

Spatial-temporal clustering of notified pulmonary tuberculosis and its predictors in East Gojjam Zone, Northwest Ethiopia

Mulusew Andualem Asemahagn  1 , Getu Degu Alene  1 , Solomon Abebe Yimer  2   3
Affiliations

Spatial-temporal clustering of notified pulmonary tuberculosis and its predictors in East Gojjam Zone, Northwest Ethiopia

Mulusew Andualem Asemahagn et al. PLoS One. .

Abstract

Background: Tuberculosis (TB) remains a key health menace in Ethiopia and its districts. This study aimed to assess the spatial-temporal clustering of notified pulmonary TB (PTB) cases in East Gojjam Zone, Northwest Ethiopia.

Methods: A retrospective study was conducted among all PTB cases reported from 2013-2019. Case notification rates (CNRs) of PTB cases at Kebele (the lowest administrative unit), woreda, and zone levels were estimated. The PTB clustering was done using global Moran's I statistics on Arc GIS 10.6. We used Kulldorff SaTScan 9.6 with a discrete Poisson model to identify statistically significant spatial-temporal clustering of PTB cases at Kebele level. Similarly, a negative binomial regression analysis was used to identify factors associated with the incidence of PTB cases at kebele level.

Results: A total of 5340 (52%) smear-positive and 4928 (48%) smear-negative PTB cases were analyzed. The overall mean CNR of PTB cases at zone, woreda and Kebele levels were 58(47-69), 82(56-204), and 69(36-347) per 100,000 population, respectively. The purely spatial cluster analysis identified eight most likely clusters (one for overall and one per year for seven reporting years) and 47 secondary clusters. Similarly, the space-time scan analysis identified one most likely and seven secondary clusters. The purely temporal analysis also detected one most likely cluster from 2013-2015. Rural residence, distance from the nearest health facility, and poor TB service readiness were factors (p-value <0.05) to PTB incidence at kebele level.

Conclusion: The distribution of PTB cases was clustered. The PTB CNR was low and showed a decreasing trend during the reporting periods. Rural residence, distance from the health facilities, and poor facility readiness were factors of PTB incidence. Improving accessibility and readiness of health facilities mainly to rural and hotspot areas is vital to increase case detection and reduce TB transmission.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Map of East Gojjam Zone, Northwest Ethiopia, 2019 (Coordinates: 9.900° to 11.193° latitude, and 37.152° to 38.489° longitude).
Fig 2
Fig 2. PTB Case notification rate per 100,000 population in East Gojjam Zone, 2013–2019.
Fig 3
Fig 3. Distribution of PTB CNR per 100000 population in East Gojjam Zone, 2013–2019 (Coordinates: 9.900° to 11.193° latitude, and 37.152° to 38.489° longitude).
Fig 4
Fig 4. Purely spatial clusters of PTB in the East Gjjam Zone, Northwest Ethiopia, 2013–2019 (Coordinates: 9.900° to 11.193° latitude, and 37.152° to 38.489° longitude).
Fig 5
Fig 5. Significant space-time clusters of PTB in East Gojjam Zone of Ethiopia, 2013–2019 (Coordinates: 9.900° to 11.193° latitude, and 37.152° to 38.489° longitude).
Fig 6
Fig 6. Purely temporal clusters of PTB cases from 2013–2019 in East Gojjam Zone.
See this image and copyright information in PMC

References

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