Abstract
Tuberculosis is one of the most contagious diseases that has been present for over 5000 years and it is still one of the most significant public health problems. This paper is intended to employ GIS in analyzing spatial variations of tuberculosis incidence in Burundi highlighting the main hot spots. Also, the paper aims to evaluate the temporal changes of TB incidence during the period 2009-2017 and guide the resource allocation. For this purpose, data on tuberculosis incidence at both province and health district level were analyzed. Data on incidence rate of TB and demographic data were collected at province level. Also, data on cases of TB recorded at health district level were acquired. The collected data were analyzed at both temporal and spatial scale. Temporal analysis involved identifying the various trends of TB incidence rate in various Burundi provinces during the period 2009-2017. Spatial analysis comprised mapping spatial variations in TB incidence rates and their trend over the period 2009-2017 and TB incidence at health district level. Moreover, Hot Spot analysis was performed to delineate those districts of statistically significant hot spots in TB incidence in Burundi. The temporal analysis of TB incidence rate, at province level, revealed that during the period 2009-2017, Burundi provinces have experienced varied trends of TB incidence with an annual change rate ranging between (-32.9) and (+5.22) in case of TB in all clinical forms and between (-12.2) and (+1.1) in case of Pulmonary TB. TB incidence rates were found to be positively correlated with proportion of urban population and population density. Meanwhile, spatial analysis of TB cases, revealed that eastern parts of Burundi have been experiencing relatively low incidence rates of TB compared to other parts of the country. This was highlighted by Hot Spot analysis that revealed a tendency of Pulmonary TB cases to be clustered and a hot spot in Pulmonary TB incidence was clearly distinguished in western parts of Burundi. Spatial temporal analysis highlights the potentials of GIS in recognizing trends and spatial pattern of such a disease and may support designing and implementing control programs and guide the resource allocation.
Highlights
Tuberculosis (TB) disease is one of major global public health problems [1, 2], with almost 1.6 million deaths in 2017 [3]
Pulmonary TB incidence rate was found to be positively correlated with proportion of urban population and population density with correlation coefficients of +0.955 and +0.940, respectively (P value < 0.01)
The results showed a significant relationship between proportion of urban population and TB incidence rates (p value < 0.01) with adjusted R2 value of 0.907 and 0.973 in case of Pulmonary TB and TB in all clinical forms, respectively
Summary
Tuberculosis (TB) disease is one of major global public health problems [1, 2], with almost 1.6 million deaths in 2017 [3]. TB leads usually to enormous socioeconomic disturbance and hinders nation’s development [4]. In this context, positive correlation was noticed between declining TB incidence rate and human development index [5]. Due to its high burden, TB was targeted by sustainable development agenda as one of the main epidemics that should be ended by 2030 [8]. Attaining such a target requires mapping tuberculosis incidence and understanding its spatial pattern. Such mapping and understanding can get insight into main determinants and deriving forces that need to be dealt with
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