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Spies R, Hong HN, Trieu PP, Lan LK, Lan K, Hue NN, Huong NTL, Thao TTLN, Quang NL, Anh TDD, Vinh TV, Ha DTM, Dat PT, Hai NP, Van LH, Thwaites GE, Thuong NTT, Watson JA, Walker TM. Spatial Analysis of Drug-Susceptible and Multidrug-Resistant Cases of Tuberculosis, Ho Chi Minh City, Vietnam, 2020-2023. Emerg Infect Dis 2024; 30:499-509. [PMID: 38407176 PMCID: PMC10902525 DOI: 10.3201/eid3003.231309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
We characterized the spatial distribution of drug-susceptible (DS) and multidrug-resistant (MDR) tuberculosis (TB) cases in Ho Chi Minh City, Vietnam, a major metropolis in southeastern Asia, and explored demographic and socioeconomic factors associated with local TB burden. Hot spots of DS and MDR TB incidence were observed in the central parts of Ho Chi Minh City, and substantial heterogeneity was observed across wards. Positive spatial autocorrelation was observed for both DS TB and MDR TB. Ward-level TB incidence was associated with HIV prevalence and the male proportion of the population. No ward-level demographic and socioeconomic indicators were associated with MDR TB case count relative to total TB case count. Our findings might inform spatially targeted TB control strategies and provide insights for generating hypotheses about the nature of the relationship between DS and MDR TB in Ho Chi Minh City and the wider southeastern region of Asia.
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Robert BN, Cherono A, Mumo E, Mwandawiro C, Okoyo C, Gichuki PM, Blanford JL, Snow RW, Okiro EA. Spatial variation and clustering of anaemia prevalence in school-aged children in Western Kenya. PLoS One 2023; 18:e0282382. [PMID: 38011142 PMCID: PMC10681207 DOI: 10.1371/journal.pone.0282382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/08/2023] [Indexed: 11/29/2023] Open
Abstract
Anaemia surveillance has overlooked school-aged children (SAC), hence information on this age group is scarce. This study examined the spatial variation of anaemia prevalence among SAC (5-14 years) in western Kenya, a region associated with high malaria infection rates. A total of 8051 SAC were examined from 82 schools across eight counties in Western Kenya in February 2022. Haemoglobin (Hb) concentrations were assessed at the school and village level and anaemia defined as Hb<11.5g/dl for age 5-11yrs and Hb <12.0g/dl for 12-14yrs after adjusting for altitude. Moran's I analysis was used to measure spatial autocorrelation, and local clusters of anaemia were mapped using spatial scan statistics and local indices of spatial association (LISA). The prevalence of anaemia among SAC was 27.8%. The spatial variation of anaemia was non-random, with Global Moran's I 0.2 (p-value < 0.002). Two significant anaemia cluster windows were identified: Cluster 1 (LLR = 38.9, RR = 1.4, prevalence = 32.0%) and cluster 2 (LLR = 23.6, RR = 1.6, prevalence = 45.5%) at schools and cluster 1 (LLR = 41.3, RR = 1.4, prevalence = 33.3%) and cluster 2 (LLR = 24.5, RR = 1.6, prevalence = 36.8%) at villages. Additionally, LISA analysis identified ten school catchments as anaemia hotspots corresponding geographically to SatScan clusters. Anaemia in the SAC is a public health problem in the Western region of Kenya with some localised areas presenting greater risk relative to others. Increasing coverage of interventions, geographically targeting the prevention of anaemia in the SAC, including malaria, is required to alleviate the burden among children attending school in Western Kenya.
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Affiliation(s)
- Bibian N. Robert
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Population and Health Impact Surveillance Group, Nairobi, Kenya
| | - Anitah Cherono
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Population and Health Impact Surveillance Group, Nairobi, Kenya
| | - Eda Mumo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Population and Health Impact Surveillance Group, Nairobi, Kenya
| | - Charles Mwandawiro
- Kenya Medical Research Institute, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, Kenya
| | - Collins Okoyo
- Kenya Medical Research Institute, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, Kenya
- Department of Epidemiology, Kenya Medical Research Institute, Statistics and Informatics (DESI), Nairobi, Kenya
| | - Paul M. Gichuki
- Kenya Medical Research Institute, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, Kenya
| | - Justine l. Blanford
- Department of Earth Observation Sciences, University of Twente, Enschede, Netherlands
| | - Robert W. Snow
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Population and Health Impact Surveillance Group, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Emelda A. Okiro
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Population and Health Impact Surveillance Group, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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Nanque AR, Ramos ACV, Moura HSD, Berra TZ, Tavares RBV, Monroe AA, Pinto IC, Arcêncio RA. Spatial and temporal analysis of tuberculosis incidence in Guinea-Bissau, 2018 to 2020. Rev Bras Enferm 2023; 76:e20220481. [PMID: 37820137 PMCID: PMC10561932 DOI: 10.1590/0034-7167-2022-0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/10/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE to analyze the epidemiological profile, spatial and temporal distribution of tuberculosis in Guinea-Bissau from 2018 to 2020. METHODS an ecological study, carried out in Guinea-Bissau, considering new cases of tuberculosis. Spatial analysis of areas was used to verify tuberculosis distribution in the country, and time series were used to identify incidence evolution over the years of study. RESULTS a total of 6,840 new cases of tuberculosis were reported. Tuberculosis incidence rate in the country ranged from 36.8 to 267.7 cases/100,000 inhabitants, with emphasis on the regions of Bissau and Biombo (over 90 cases/100,000). By using time series, it was possible to observe an increase in case incidence over the years of study. CONCLUSIONS the study made it possible to identify the epidemiological profile of tuberculosis in Guinea-Bissau, spatial distribution heterogeneity, in addition to identifying the disease evolution over the years of investigation.
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Aidi MN, Wulandari C, Oktarina SD, Aditra TR, Ernawati F, Efriwati E, Nurjanah N, Rachmawati R, Julianti ED, Sundari D, Retiaty F, Arifin AY, Dewi RM, Nazaruddin N, Salimar S, Fuada N, Widodo Y, Setyawati B, Nurhidayati N, Sudikno S, Irawan IR, Widoretno W. Province clustering based on the percentage of communicable disease using the BCBimax biclustering algorithm. GEOSPATIAL HEALTH 2023; 18. [PMID: 37698368 DOI: 10.4081/gh.2023.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/09/2023] [Indexed: 09/13/2023]
Abstract
Indonesia needs to lower its high infectious disease rate. This requires reliable data and following their temporal changes across provinces. We investigated the benefits of surveying the epidemiological situation with the imax biclustering algorithm using secondary data from a recent national scale survey of main infectious diseases from the National Basic Health Research (Riskesdas) covering 34 provinces in Indonesia. Hierarchical and k-means clustering can only handle one data source, but BCBimax biclustering can cluster rows and columns in a data matrix. Several experiments determined the best row and column threshold values, which is crucial for a useful result. The percentages of Indonesia's seven most common infectious diseases (ARI, pneumonia, diarrhoea, tuberculosis (TB), hepatitis, malaria, and filariasis) were ordered by province to form groups without considering proximity because clusters are usually far apart. ARI, pneumonia, and diarrhoea were divided into toddler and adult infections, making 10 target diseases instead of seven. The set of biclusters formed based on the presence and level of these diseases included 7 diseases with moderate to high disease levels, 5 diseases (formed by 2 clusters), 3 diseases, 2 diseases, and a final order that only included adult diarrhoea. In 6 of 8 clusters, diarrhea was the most prevalent infectious disease in Indonesia, making its eradication a priority. Direct person-to-person infections like ARI, pneumonia, TB, and diarrhoea were found in 4-6 of 8 clusters. These diseases are more common and spread faster than vector-borne diseases like malaria and filariasis, making them more important.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Dian Sundari
- National Research and Innovation Agency, Jakarta.
| | - Fifi Retiaty
- National Research and Innovation Agency, Jakarta.
| | | | | | | | | | | | - Yekti Widodo
- National Research and Innovation Agency, Jakarta.
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Teibo TKA, Andrade RLDP, Rosa RJ, Tavares RBV, Berra TZ, Arcêncio RA. Geo-spatial high-risk clusters of Tuberculosis in the global general population: a systematic review. BMC Public Health 2023; 23:1586. [PMID: 37598144 PMCID: PMC10439548 DOI: 10.1186/s12889-023-16493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
INTRODUCTION The objective of this systematic review is to identify tuberculosis (TB) high-risk among the general population globally. The review was conducted using the following steps: elaboration of the research question, search for relevant publications, selection of studies found, data extraction, analysis, and evidence synthesis. METHODS The studies included were those published in English, from original research, presented findings relevant to tuberculosis high-risk across the globe, published between 2017 and 2023, and were based on geospatial analysis of TB. Two reviewers independently selected the articles and were blinded to each other`s comments. The resultant disagreement was resolved by a third blinded reviewer. For bibliographic search, controlled and free vocabularies that address the question to be investigated were used. The searches were carried out on PubMed, LILACS, EMBASE, Scopus, and Web of Science. and Google Scholar. RESULTS A total of 79 published articles with a 40-year study period between 1982 and 2022 were evaluated. Based on the 79 studies, more than 40% of all countries that have carried out geospatial analysis of TB were from Asia, followed by South America with 23%, Africa had about 15%, and others with 2% and 1%. Various maps were used in the various studies and the most used is the thematic map (32%), rate map (26%), map of temporal tendency (20%), and others like the kernel density map (6%). The characteristics of the high-risk and the factors that affect the hotspot's location are evident through studies related to poor socioeconomic conditions constituting (39%), followed by high population density (17%), climate-related clustering (15%), high-risk spread to neighbouring cities (13%), unstable and non-random cluster (11%). CONCLUSION There exist specific high-risk for TB which are areas that are related to low socioeconomic conditions and spectacular weather conditions, these areas when well-known will be easy targets for intervention by policymakers. We recommend that more studies making use of spatial, temporal, and spatiotemporal analysis be carried out to point out territories and populations that are vulnerable to TB.
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Affiliation(s)
- Titilade Kehinde Ayandeyi Teibo
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil.
| | - Rubia Laine de Paula Andrade
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Rander Junior Rosa
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Reginaldo Bazon Vaz Tavares
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Thais Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
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Spatial-temporal analysis of pulmonary tuberculosis in Hubei Province, China, 2011-2021. PLoS One 2023; 18:e0281479. [PMID: 36749779 PMCID: PMC9904469 DOI: 10.1371/journal.pone.0281479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pulmonary tuberculosis (PTB) is an infectious disease of major public health problem, China is one of the PTB high burden counties in the word. Hubei is one of the provinces having the highest notification rate of tuberculosis in China. This study analyzed the temporal and spatial distribution characteristics of PTB in Hubei province for targeted intervention on TB epidemics. METHODS The data on PTB cases were extracted from the National Tuberculosis Information Management System correspond to population in 103 counties of Hubei Province from 2011 to 2021. The effect of PTB control was measured by variation trend of bacteriologically confirmed PTB notification rate and total PTB notification rate. Time series, spatial autonomic correlation and spatial-temporal scanning methods were used to identify the temporal trends and spatial patterns at county level of Hubei. RESULTS A total of 436,955 cases were included in this study. The total PTB notification rate decreased significantly from 81.66 per 100,000 population in 2011 to 52.25 per 100,000 population in 2021. The peak of PTB notification occurred in late spring and early summer annually. This disease was spatially clustering with Global Moran's I values ranged from 0.34 to 0.63 (P< 0.01). Local spatial autocorrelation analysis indicated that the hot spots are mainly distributed in the southwest and southeast of Hubei Province. Using the SaTScan 10.0.2 software, results from the staged spatial-temporal analysis identified sixteen clusters. CONCLUSIONS This study identified seasonal patterns and spatial-temporal clusters of PTB cases in Hubei province. High-risk areas in southwestern Hubei still exist, and need to focus on and take targeted control and prevention measures.
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A spatial analysis of TB cases and abnormal X-rays detected through active case-finding in Karachi, Pakistan. Sci Rep 2023; 13:1336. [PMID: 36693930 PMCID: PMC9873642 DOI: 10.1038/s41598-023-28529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Tuberculosis (TB) is the leading cause of avoidable deaths from an infectious disease globally and a large of number of people who develop TB each year remain undiagnosed. Active case-finding has been recommended by the World Health Organization to bridge the case-detection gap for TB in high burden countries. However, concerns remain regarding their yield and cost-effectiveness. Data from mobile chest X-ray (CXR) supported active case-finding community camps conducted in Karachi, Pakistan from July 2018 to March 2020 was retrospectively analyzed. Frequency analysis was carried out at the camp-level and outcomes of interest for the spatial analyses were mycobacterium TB positivity (MTB+) and X-ray abnormality rates. The Global Moran's I statistic was used to test for spatial autocorrelation for MTB+ and abnormal X-rays within Union Councils (UCs) in Karachi. A total of 1161 (78.1%) camps yielded no MTB+ cases, 246 (16.5%) camps yielded 1 MTB+, 52 (3.5%) camps yielded 2 MTB+ and 27 (1.8%) yielded 3 or more MTB+. A total of 79 (5.3%) camps accounted for 193 (44.0%) of MTB+ cases detected. Statistically significant clustering for MTB positivity (Global Moran's I: 0.09) and abnormal chest X-rays (Global Moran's I: 0.36) rates was identified within UCs in Karachi. Clustering of UCs with high MTB positivity were identified in Karachi West district. Statistically significant spatial variation was identified in yield of bacteriologically positive TB cases and in abnormal CXR through active case-finding in Karachi. Cost-effectiveness of active case-finding programs can be improved by identifying and focusing interventions in hotspots and avoiding locations with no known TB cases reported through routine surveillance.
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Dao TP, Hoang XHT, Nguyen DN, Huynh NQ, Pham TT, Nguyen DT, Nguyen HB, Do NH, Nguyen HV, Dao CH, Nguyen NV, Bui HM. A geospatial platform to support visualization, analysis, and prediction of tuberculosis notification in space and time. Front Public Health 2022; 10:973362. [PMID: 36159240 PMCID: PMC9500499 DOI: 10.3389/fpubh.2022.973362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
Background Tuberculosis has caused significant public health and economic burdens in Vietnam over the years. The Vietnam National Tuberculosis Program is facing considerable challenges in its goal to eliminate tuberculosis by 2030, with the COVID-19 pandemic having negatively impacted routine tuberculosis services at all administrative levels. While the turnaround time of tuberculosis infection may delay disease detection, high transportation frequency could potentially mislead epidemiological studies. This study was conducted to develop an online geospatial platform to support healthcare workers in performing data visualization and promoting the active case surveillance in community as well as predicting the TB incidence in space and time. Method This geospatial platform was developed using tuberculosis notification data managed by The Vietnam National Tuberculosis Program. The platform allows case distribution to be visualized by administrative level and time. Users can retrieve epidemiological measurements from the platform, which are calculated and visualized both temporally and spatially. The prediction model was developed to predict the TB incidence in space and time. Results An online geospatial platform was developed, which presented the prediction model providing estimates of case detection. There were 400,370 TB cases with bacterial evidence to be included in the study. We estimated that the prevalence of TB in Vietnam was at 414.67 cases per 100.000 population. Ha Noi, Da Nang, and Ho Chi Minh City were predicted as three likely epidemiological hotspots in the near future. Conclusion Our findings indicate that increased efforts should be undertaken to control tuberculosis transmission in these hotspots.
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Affiliation(s)
| | - Xuyen Hong Thi Hoang
- Hanoi Medical University Hospital, Hanoi, Vietnam,Hanoi Medical University, Hanoi, Vietnam
| | | | | | | | | | | | | | | | | | | | - Hanh My Bui
- Hanoi Medical University Hospital, Hanoi, Vietnam,Hanoi Medical University, Hanoi, Vietnam,*Correspondence: Hanh My Bui
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Mohammadi A, Bergquist R, Fathi G, Pishgar E, de Melo SN, Sharifi A, Kiani B. Homicide rates are spatially associated with built environment and socio-economic factors: a study in the neighbourhoods of Toronto, Canada. BMC Public Health 2022; 22:1482. [PMID: 35927698 PMCID: PMC9351166 DOI: 10.1186/s12889-022-13807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/14/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives Homicide rate is associated with a large variety of factors and therefore unevenly distributed over time and space. This study aims to explore homicide patterns and their spatial associations with different socioeconomic and built-environment conditions in 140 neighbourhoods of the city of Toronto, Canada. Methods A homicide dataset covering the years 2012 to 2021 and neighbourhood-based indicators were analysed using spatial techniques such as Kernel Density Estimation, Global/Local Moran’s I and Kulldorff’s SatScan spatio-temporal methodology. Geographically weighted regression (GWR) and multi-scale GWR (MGWR) were used to analyse the spatially varying correlations between the homicide rate and independent variables. The latter was particularly suitable for manifested spatial variations between explanatory variables and the homicide rate and it also identified spatial non-stationarities in this connection. Results The adjusted R2 of the MGWR was 0.53, representing a 4.35 and 3.74% increase from that in the linear regression and GWR models, respectively. Spatial and spatio-temporal high-risk areas were found to be significantly clustered in downtown and the north-western parts of the city. Some variables (e.g., the population density, material deprivation, the density of commercial establishments and the density of large buildings) were significantly associated with the homicide rate in different spatial ways. Conclusion The findings of this study showed that homicide rates were clustered over time and space in certain areas of the city. Socioeconomic and the built environment characteristics of some neighbourhoods were found to be associated with high homicide rates but these factors were different for each neighbourhood. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13807-4.
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Affiliation(s)
- Alireza Mohammadi
- Department of Geography and Urban Planning, Faculty of Social Sciences, University of MohagheghArdabili, Ardabil, Iran.
| | - Robert Bergquist
- Ingerod, Brastad, SE-454 94 Sweden. Formerly UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Ghasem Fathi
- Department of Geography and Urban Planning, Faculty of Social Sciences, University of MohagheghArdabili, Ardabil, Iran
| | - Elahe Pishgar
- Department of Human Geography, Faculty of Earth Sciences, Shahid Beheshti University, Tehran, Iran
| | - Silas Nogueira de Melo
- Department of Geography, State University of Maranhão, CidadeUniversitária Paulo VI, São Luís, 65055-000, Brazil
| | - Ayyoob Sharifi
- Graduate School of Humanities and Social Sciences, and Network for Education and Research on Peace and Sustainability, Hiroshima University, Higashi-Hiroshima, 739-8530, Japan
| | - Behzad Kiani
- Centre de Recherche en Santé Publique, Université de Montréal, 7101, Avenue du Parc, Montréal, Canada.
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Friebel-Klingner TM, Iyer HS, Ramogola-Masire D, Bazzett-Matabele L, Monare B, Seiphetlheng A, Ralefala TB, Mitra N, Wiebe DJ, Rebbeck TR, Grover S, McCarthy AM. Evaluating the geographic distribution of cervical cancer patients presenting to a multidisciplinary gynecologic oncology clinic in Gaborone, Botswana. PLoS One 2022; 17:e0271679. [PMID: 35925976 PMCID: PMC9352107 DOI: 10.1371/journal.pone.0271679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/05/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE In Botswana, cervical cancer is the leading cause of cancer death for females. With limited resources, Botswana is challenged to ensure equitable access to advanced cancer care. Botswana's capital city, Gaborone, houses the only gynecologic oncology multi-disciplinary team (MDT) and the one chemoradiation facility in the country. We aimed to identify areas where fewer women were presenting to the MDT clinic for care. METHODS This cross-sectional study examined cervical cancer patients presenting to the MDT clinic between January 2015 and March 2020. Patients were geocoded to residential sub-districts to estimate age-standardized presentation rates. Global Moran's I and Anselin Local Moran's I tested the null hypothesis that presentation rates occurred randomly in Botswana. Community- and individual-level factors of patients living in sub-districts identified with higher (HH) and lower (LL) clusters of presentation rates were examined using ordinary least squares with a spatial weights matrix and multivariable logistic regression, respectively, with α level 0.05. RESULTS We studied 990 patients aged 22-95 (mean: 50.6). Presentation rates were found to be geographically clustered across the country (p = 0.01). Five sub-districts were identified as clusters, two high (HH) sub-district clusters and three low (LL) sub-district clusters (mean presentation rate: 35.5 and 11.3, respectively). Presentation rates decreased with increased travel distance (p = 0.033). Patients residing in LL sub-districts more often reported abnormal vaginal bleeding (aOR: 5.62, 95% CI: 1.31-24.15) compared to patients not residing in LL sub-districts. Patients in HH sub-districts were less likely to be living with HIV (aOR: 0.59; 95% CI: 0.38-0.90) and more likely to present with late-stage cancer (aOR: 1.78; 95%CI: 1.20-2.63) compared to patients not in HH sub-districts. CONCLUSIONS This study identified geographic clustering of cervical cancer patients presenting for care in Botswana and highlighted sub-districts with disproportionately lower presentation rates. Identified community- and individual level-factors associated with low presentation rates can inform strategies aimed at improving equitable access to cervical cancer care.
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Affiliation(s)
- Tara M. Friebel-Klingner
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Hari S. Iyer
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut, United States of America
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut, United States of America
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | | | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Douglas J. Wiebe
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Timothy R. Rebbeck
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Oostvogels S, Ley SD, Heupink TH, Dippenaar A, Streicher EM, De Vos E, Meehan CJ, Dheda K, Warren R, Van Rie A. Transmission, distribution and drug resistance-conferring mutations of extensively drug-resistant tuberculosis in the Western Cape Province, South Africa. Microb Genom 2022; 8. [PMID: 35471145 PMCID: PMC9453078 DOI: 10.1099/mgen.0.000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Extensively drug-resistant tuberculosis (XDR-TB), defined as resistance to at least isoniazid (INH), rifampicin (RIF), a fluoroquinolone (FQ) and a second-line injectable drug (SLID), is difficult to treat and poses a major threat to TB control. The transmission dynamics and distribution of XDR Mycobacterium tuberculosis (Mtb) strains have not been thoroughly investigated. Using whole genome sequencing data on 461 XDR-Mtb strains, we aimed to investigate the geographical distribution of XDR-Mtb strains in the Western Cape Province of South Africa over a 10 year period (2006–2017) and assess the association between Mtb sub-lineage, age, gender, geographical patient location and membership or size of XDR-TB clusters. First, we identified transmission clusters by excluding drug resistance-conferring mutations and using the 5 SNP cutoff, followed by merging clusters based on their most recent common ancestor. We then consecutively included variants conferring resistance to INH, RIF, ethambutol (EMB), pyrazinamide (PZA), SLIDs and FQs in the cluster definition. Cluster sizes were classified as small (2–4 isolates), medium (5–20 isolates), large (21–100 isolates) or very large (>100 isolates) to reflect the success of individual strains. We found that most XDR-TB strains were clustered and that including variants conferring resistance to INH, RIF, EMB, PZA and SLIDs in the cluster definition did not significantly reduce the proportion of clustered isolates (85.5–82.2 %) but increased the number of patients belonging to small clusters (4.3–12.4 %, P=0.56). Inclusion of FQ resistance-conferring variants had the greatest effect, with 11 clustered isolates reclassified as unique while the number of clusters increased from 17 to 37. Lineage 2 strains (lineage 2.2.1 typical Beijing or lineage 2.2.2 atypical Beijing) showed the large clusters which were spread across all health districts of the Western Cape Province. We identified a significant association between residence in the Cape Town metropole and cluster membership (P=0.016) but no association between gender, age and cluster membership or cluster size (P=0.39). Our data suggest that the XDR-TB epidemic in South Africa probably has its origin in the endemic spread of MDR Mtb and pre-XDR Mtb strains followed by acquisition of FQ resistance, with more limited transmission of XDR Mtb strains. This only became apparent with the inclusion of drug resistance-conferring variants in the definition of a cluster. In addition to the prevention of amplification of resistance, rapid diagnosis of MDR, pre-XDR and XDR-TB and timely initiation of appropriate treatment is needed to reduce transmission of difficult-to-treat TB.
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Affiliation(s)
- Selien Oostvogels
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- *Correspondence: Selien Oostvogels,
| | - Serej D. Ley
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
- Present address: Sefunda AG, Muttenz, Switzerland
| | - Tim H. Heupink
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Anzaan Dippenaar
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Unit of Mycobacteriology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Elizabeth M. Streicher
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Elise De Vos
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Conor J. Meehan
- Unit of Mycobacteriology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biosciences, Nottingham Trent University, Nottingham, UK
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rob Warren
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Annelies Van Rie
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Jiang H, Sun X, Hua Z, Liu H, Cao Y, Ren D, Qi X, Zhang T, Zhang S. Distribution of bacteriologically positive and bacteriologically negative pulmonary tuberculosis in Northwest China: spatiotemporal analysis. Sci Rep 2022; 12:6895. [PMID: 35477716 PMCID: PMC9046232 DOI: 10.1038/s41598-022-10675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/04/2022] [Indexed: 11/09/2022] Open
Abstract
Pulmonary tuberculosis (PTB) is a major health issue in Northwest China. Most previous studies on the spatiotemporal patterns of PTB considered all PTB cases as a whole; they did not distinguish notified bacteriologically positive PTB (BP-PTB) and notified bacteriologically negative PTB (BN-PTB). Thus, the spatiotemporal characteristics of notified BP-PTB and BN-PTB are still unclear. A retrospective county-level spatial epidemiological study (2011-2018) was conducted in Shaanxi, Northwest China. In total, 44,894 BP-PTB cases were notified, with an average annual incidence rate of 14.80 per 100,000 persons between 2011 and 2018. Global Moran's I values for notified BP-PTB ranged from 0.19 to 0.49 (P < 0.001). Anselin's local Moran's I analysis showed that the high-high (HH) cluster for notified BP-PTB incidence was mainly located in the southernmost region. The primary spatiotemporal cluster for notified BP-PTB (LLR = 612.52, RR = 1.77, P < 0.001) occurred in the central region of the Guanzhong Plain in 2011. In total, 116,447 BN-PTB cases were notified, with an average annual incidence rate of 38.38 per 100,000 persons between 2011 and 2018. Global Moran's I values for notified BN-PTB ranged from 0.39 to 0.69 (P < 0.001). The HH clusters of notified BN-PTB were mainly located in the north between 2011 and 2014 and in the south after 2015. The primary spatiotemporal cluster for notified BN-PTB (LLR = 1084.59, RR = 1.85, P < 0.001) occurred in the mountainous areas of the southernmost region from 2014 to 2017. Spatiotemporal clustering of BP-PTB and BN-PTB was detected in the poverty-stricken mountainous areas of Shaanxi, Northwest China. Our study provides evidence for intensifying PTB control activities in these geographical clusters.
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Affiliation(s)
- Hualin Jiang
- Health Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xiaolu Sun
- Shaanxi Provincial Institute for Tuberculosis Control and Prevention, Xi'an, 710048, China
| | - Zhongqiu Hua
- Wuxi Early Intervention Centre for Children With Special Needs, Wuxi, 214000, China
| | - Haini Liu
- Shangluo University, Shangluo, 726000, China
| | - Yi Cao
- Health Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dan Ren
- Health Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xin Qi
- Health Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Tianhua Zhang
- Shaanxi Provincial Institute for Tuberculosis Control and Prevention, Xi'an, 710048, China.
| | - Shaoru Zhang
- Health Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China.
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Kiani B, Raouf Rahmati A, Bergquist R, Hashtarkhani S, Firouraghi N, Bagheri N, Moghaddas E, Mohammadi A. Spatio-temporal epidemiology of the tuberculosis incidence rate in Iran 2008 to 2018. BMC Public Health 2021; 21:1093. [PMID: 34098917 PMCID: PMC8186231 DOI: 10.1186/s12889-021-11157-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background Effective reduction of tuberculosis (TB) requires information on the distribution of TB incidence rate across time and location. This study aims to identify the spatio-temporal pattern of TB incidence rate in Iran between 2008 and 2018. Methods This cross-sectional study was conducted on aggregated TB data (50,500 patients) at the provincial level provided by the Ministry of Health in Iran between 2008 and 2018. The Anselin Local Moran’s I and Getis-Ord Gi* were performed to identify the spatial variations of the disease. Furthermore, spatial scan statistic was employed for purely temporal and spatio-temporal analyses. In all instances, the null hypothesis of no clusters was rejected at p ≤ 0.05. Results The overall incidence rate of TB decreased from 13.46 per 100,000 (95% CI: 13.19–13.73) in 2008 to 10.88 per 100,000 (95% CI: 10.65–11.11) in 2018. The highest incidence rate of TB was observed in southeast and northeast of Iran for the whole study period. Additionally, spatial cluster analysis discovered Khuzestan Province, in the West of the country, having significantly higher rates than neighbouring provinces in terms of both total TB and smear-positive pulmonary TB (SPPTB). Purely temporal analysis showed that high-rate and low-rate clusters were predominantly distributed in the time periods 2010–2014 and 2017–2018. Spatio-temporal results showed that the statistically significant clusters were mainly distributed from centre to the east during the study period. Some high-trend TB and SPPTB statistically significant clusters were found. Conclusion The results provided an overview of the latest TB spatio-temporal status In Iran and identified decreasing trends of TB in the 2008–2018 period. Despite the decreasing incidence rate, there is still need for screening, and targeting of preventive interventions, especially in high-risk areas. Knowledge of the spatio-temporal pattern of TB can be useful for policy development as the information regarding the high-risk areas would contribute to the selection of areas needed to be targeted for the expansion of health facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11157-1.
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Affiliation(s)
- Behzad Kiani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amene Raouf Rahmati
- Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robert Bergquist
- Ingerod, Brastad, Lysekil, Sweden.,formerly with the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Soheil Hashtarkhani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Firouraghi
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasser Bagheri
- Center for Mental Health Research College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Elham Moghaddas
- Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Alireza Mohammadi
- Department of Geography and Urban Planning, Faculty of Social Sciences, University of Mohaghegh Ardabili, Ardabil, Iran.
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Gwitira I, Karumazondo N, Shekede MD, Sandy C, Siziba N, Chirenda J. Spatial patterns of pulmonary tuberculosis (TB) cases in Zimbabwe from 2015 to 2018. PLoS One 2021; 16:e0249523. [PMID: 33831058 PMCID: PMC8031317 DOI: 10.1371/journal.pone.0249523] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/21/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Accurate mapping of spatial heterogeneity in tuberculosis (TB) cases is critical for achieving high impact control as well as guide resource allocation in most developing countries. The main aim of this study was to explore the spatial patterns of TB occurrence at district level in Zimbabwe from 2015 to 2018 using GIS and spatial statistics as a preamble to identifying areas with elevated risk for prioritisation of control and intervention measures. METHODS In this study Getis-Ord Gi* statistics together with SaTscan were used to characterise TB hotspots and clusters in Zimbabwe at district level from 2015 to 2018. GIS software was used to map and visualise the results of cluster analysis. RESULTS Results show that TB occurrence exhibits spatial heterogeneity across the country. The TB hotspots were detected in the central, western and southern part of the country. These areas are characterised by artisanal mining activities as well as high poverty levels. CONCLUSIONS AND RECOMMENDATIONS Results of this study are useful to guide TB control programs and design effective strategies which are important in achieving the United Nations Sustainable Development goals (UNSDGs).
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Affiliation(s)
- Isaiah Gwitira
- Department of Geography Geospatial Sciences and Earth Observation, Faculty of Science, University of Zimbabwe, Harare, Zimbabwe
| | - Norbert Karumazondo
- Department of Geography Geospatial Sciences and Earth Observation, Faculty of Science, University of Zimbabwe, Harare, Zimbabwe
| | - Munyaradzi Davis Shekede
- Department of Geography Geospatial Sciences and Earth Observation, Faculty of Science, University of Zimbabwe, Harare, Zimbabwe
| | - Charles Sandy
- National TB Control Program, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Nicolas Siziba
- National TB Control Program, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Joconiah Chirenda
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Parirenyatwa Hospital, University of Zimbabwe, Harare, Zimbabwe
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