Bayesian mapping of pulmonary tuberculosis in Antananarivo, Madagascar
Bayesian mapping of pulmonary tuberculosis in Antananarivo, Madagascar
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DOI：
10.1186/1471-2334-10-21
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发表时间：
2010-02-05
影响因子：
3.7
通讯作者：
Bicout, Dominique J.
中科院分区：
文献类型：
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作者：
Randremanana, Rindra V.;Richard, Vincent;Bicout, Dominique J.
背景：结核病是一种由结核分枝杆菌引起的传染病，在马达加斯加流行。首都塔那那利佛是受灾最严重的地区。在这种情况下，结核病具有非随机的空间分布，并聚集在较贫穷的地区。本研究的目的是通过贝叶斯方法进一步探索这一模式，并测量所有社区结核病风险的空间变化与国家控制规划指标之间的关联。方法：采用贝叶斯方法和广义线性混合模型（GLMM）相结合的方法生成平滑的结核病风险图，并对结核病新发病例与国家结核病控制规划指标之间的关系进行建模。结核病新病例收集自2004年至2006年本市16个结核病诊断和治疗中心的记录。在分析中考虑了五项结核病指标：接受再治疗的病例数、治疗失败的患者数和治疗完成后复发的患者数、有一个以上病例的家庭数、失去随访的患者数以及距离结核病治疗中心的距离。结果：塔那那利佛市43.23%的社区标准化发病率（SIR）大于1，其中19.28%的社区结核病风险显著高于平均水平。已确定的结核病高风险地区聚集在一起，发现结核病的分布主要与失去随访的患者数量（SIR: 1.10, CI 95%: 1.02-1.19）和有一个以上病例的家庭数量（SIR: 1.13, CI 95%: 1.03-1.24）相关。结论：塔那那利佛结核病的空间格局以及国家控制规划指标对该格局的贡献突出了结核病登记处记录的数据和使用空间方法评估结核病流行病学状况的重要性。将这些变量包含到模型中可以提高再现性，因为这些数据已经可用于各个dtc。这些发现也可能有助于指导与疾病控制策略有关的决策。
Background: Tuberculosis ( TB), an infectious disease caused by the Mycobacterium tuberculosis is endemic in Madagascar. The capital, Antananarivo is the most seriously affected area. TB had a non-random spatial distribution in this setting, with clustering in the poorer areas. The aim of this study was to explore this pattern further by a Bayesian approach, and to measure the associations between the spatial variation of TB risk and national control program indicators for all neighbourhoods.Methods: Combination of a Bayesian approach and a generalized linear mixed model (GLMM) was developed to produce smooth risk maps of TB and to model relationships between TB new cases and national TB control program indicators. The TB new cases were collected from records of the 16 Tuberculosis Diagnostic and Treatment Centres (DTC) of the city from 2004 to 2006. And five TB indicators were considered in the analysis: number of cases undergoing retreatment, number of patients with treatment failure and those suffering relapse after the completion of treatment, number of households with more than one case, number of patients lost to follow-up, and proximity to a DTC.Results: In Antananarivo, 43.23% of the neighbourhoods had a standardized incidence ratio ( SIR) above 1, of which 19.28% with a TB risk significantly higher than the average. Identified high TB risk areas were clustered and the distribution of TB was found to be associated mainly with the number of patients lost to follow-up ( SIR: 1.10, CI 95%: 1.02-1.19) and the number of households with more than one case ( SIR: 1.13, CI 95%: 1.03-1.24).Conclusion: The spatial pattern of TB in Antananarivo and the contribution of national control program indicators to this pattern highlight the importance of the data recorded in the TB registry and the use of spatial approaches for assessing the epidemiological situation for TB. Including these variables into the model increases the reproducibility, as these data are already available for individual DTCs. These findings may also be useful for guiding decisions related to disease control strategies.