Mapping tuberculosis treatment outcomes in Ethiopia
Mapping tuberculosis treatment outcomes in Ethiopia
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DOI：
10.1186/s12879-019-4099-8
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发表时间：
2019-05-28
影响因子：
3.7
通讯作者：
Clements, Archie C. A.
中科院分区：
文献类型：
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作者：
Alene, Kefyalew Addis;Viney, Kerri;Clements, Archie C. A.
在埃塞俄比亚，结核病(TB)是一种传染病导致的主要死亡原因，每年导致3万多人死亡。这项研究旨在确定埃塞俄比亚各地结核病治疗结果不佳的比率是否在地区和地区一级存在地理差异，以及这种差异是否与社会经济、行为、医疗保健机会或气候条件有关。方法使用2015-2017年期间向卫生管理信息系统(HMIS)报告的国家结核病数据进行地理空间分析。通过将治疗失败、死亡和失访的总和除以结核病患者总数来计算结核病治疗结果差的流行率。计算二项Logistic回归模型，并使用贝叶斯框架进行空间分析。利用马尔可夫链蒙特卡罗(MCMC)模拟产生参数估计。使用Getis-Ord Gi*统计量以及全球和当地Moran‘s I统计量评估地理聚集性。结果在研究期间，埃塞俄比亚722个区共报告了223,244名结核病患者。治愈63556例(28.5%)，完成治疗139,633例(62.4%)，死亡6716例(3.0%)，治疗失败1459例(0.7%)，失访12200例(5.5%)。结核病治疗结果不佳的总体流行率为9.0%(范围为1-58%)。在阿法尔、甘贝利亚和索马里地区的国际边界附近地区发现了结核病治疗结果不佳的热点和聚集性，在奥罗米亚和阿姆哈拉地区发现了冷点。贫困结核病治疗结果的空间聚集性与低财富指数人口比例(OR：1.01；95%CI：1.0，1.01)、结核病知识贫乏人口比例(OR：1.02；95%CI：1.01，1.03)、年平均每摄氏度温度较高(OR：1.15；95%CI：1.08，1.21)呈正相关。结论本研究显示埃塞俄比亚贫困结核病治疗结果存在显著的空间差异，这与潜在的社会经济状况、结核病知识和气候条件有关。临床和公共卫生干预应针对热点地区，以减少糟糕的结核病治疗结果，并实现国家结束结核病战略目标。
BackgroundTuberculosis (TB) is the leading cause of death from an infectious disease in Ethiopia, killing more than 30 thousand people every year. This study aimed to determine whether the rates of poor TB treatment outcome varied geographically across Ethiopia at district and zone levels and whether such variability was associated with socioeconomic, behavioural, health care access, or climatic conditions.MethodsA geospatial analysis was conducted using national TB data reported to the health management information system (HMIS), for the period 2015-2017. The prevalence of poor TB treatment outcomes was calculated by dividing the sum of treatment failure, death and loss to follow-up by the total number of TB patients. Binomial logistic regression models were computed and a spatial analysis was performed using a Bayesian framework. Estimates of parameters were generated using Markov chain Monte Carlo (MCMC) simulation. Geographic clustering was assessed using the Getis-Ord Gi* statistic, and global and local Moran's I statistics.ResultsA total of 223,244TB patients were reported from 722 districts in Ethiopia during the study period. Of these, 63,556 (28.5%) were cured, 139,633 (62.4%) completed treatment, 6716 (3.0%) died, 1459 (0.7%) had treatment failure, and 12,200 (5.5%) were lost to follow-up. The overall prevalence of a poor TB treatment outcome was 9.0% (range, 1-58%). Hot-spots and clustering of poor TB treatment outcomes were detected in districts near the international borders in Afar, Gambelia, and Somali regions and cold spots were detected in Oromia and Amhara regions. Spatial clustering of poor TB treatment outcomes was positively associated with the proportion of the population with low wealth index (OR: 1.01; 95%CI: 1.0, 1.01), the proportion of the population with poor knowledge about TB (OR: 1.02; 95%CI: 1.01, 1.03), and higher annual mean temperature per degree Celsius (OR: 1.15; 95% CI: 1.08, 1.21).ConclusionsThis study showed significant spatial variation in poor TB treatment outcomes in Ethiopia that was related to underlying socioeconomic status, knowledge about TB, and climatic conditions. Clinical and public health interventions should be targeted in hot spot areas to reduce poor TB treatment outcomes and to achieve the national End-TB Strategy targets.