Spatial patterns of multidrug resistant tuberculosis and relationships to socio-economic, demographic and household factors in northwest Ethiopia
Open Access
- 9 February 2017
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 12 (2), e0171800
- https://doi.org/10.1371/journal.pone.0171800
Abstract
Understanding the geographical distribution of multidrug-resistant tuberculosis (MDR-TB) in high TB burden countries such as Ethiopia is crucial for effective control of TB epidemics in these countries, and thus globally. We present the first spatial analysis of multidrug resistant tuberculosis, and its relationship to socio-economic, demographic and household factors in northwest Ethiopia. An ecological study was conducted using data on patients diagnosed with MDR-TB at the University of Gondar Hospital MDR-TB treatment centre, for the period 2010 to 2015. District level population data were extracted from the Ethiopia National and Regional Census Report. Spatial autocorrelation was explored using Moran’s I statistic, Local Indicators of Spatial Association (LISA), and the Getis-Ord statistics. A multivariate Poisson regression model was developed with a conditional autoregressive (CAR) prior structure, and with posterior parameters estimated using a Bayesian Markov chain Monte Carlo (MCMC) simulation approach with Gibbs sampling, in WinBUGS. A total of 264 MDR-TB patients were included in the analysis. The overall crude incidence rate of MDR-TB for the six-year period was 3.0 cases per 100,000 population. The highest incidence rate was observed in Metema (21 cases per 100,000 population) and Humera (18 cases per 100,000 population) districts; whereas nine districts had zero cases. Spatial clustering of MDR-TB was observed in districts located in the Ethiopia-Sudan and Ethiopia-Eritrea border regions, where large numbers of seasonal migrants live. Spatial clustering of MDR-TB was positively associated with urbanization (RR: 1.02; 95%CI: 1.01, 1.04) and the percentage of men (RR: 1.58; 95% CI: 1.26, 1.99) in the districts; after accounting for these factors there was no residual spatial clustering. Spatial clustering of MDR-TB, fully explained by demographic factors (urbanization and percent male), was detected in the border regions of northwest Ethiopia, in locations where seasonal migrants live and work. Cross-border initiatives including options for mobile TB treatment and follow up are important for the effective control of MDR-TB in the region.This publication has 30 references indexed in Scilit:
- High clustering rates of multidrug-resistant Mycobacterium tuberculosisgenotypes in PanamaBMC Infectious Diseases, 2013
- Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa: a case control studyBMC Public Health, 2013
- A commentary on studies presenting projections of the future prevalence of dementiaBMC Public Health, 2013
- Antiviral Resistance and Correlates of Virologic Failure in the first Cohort of HIV-Infected Children Gaining Access to Structured Antiretroviral Therapy in Lima, Peru: A Cross-Sectional AnalysisBMC Infectious Diseases, 2013
- Assessing spatial heterogeneity of multidrug-resistant tuberculosis in a high-burden countryEuropean Respiratory Journal, 2012
- Minimum package for cross-border TB control and care in the WHO European region: a Wolfheze consensus statementEuropean Respiratory Journal, 2012
- Identifying multidrug resistant tuberculosis transmission hotspots using routinely collected dataTuberculosis, 2012
- Assessing spatiotemporal patterns of multidrug-resistant and drug-sensitive tuberculosis in a South American settingEpidemiology and Infection, 2010
- Drivers of tuberculosis epidemics: The role of risk factors and social determinantsSocial Science & Medicine (1982), 2009
- Tuberculin status, socioeconomic differences and differences in all-cause mortality: experience from Norwegian cohorts born 1910–49International Journal of Epidemiology, 2009