Abstract
BackgroundEffective 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.MethodsThis 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.ResultsThe 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.ConclusionThe 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.
Highlights
Effective reduction of tuberculosis (TB) requires information on the distribution of TB incidence rate across time and location
The highest incidence of infection was due to smear-positive pulmonary TB (SPPTB), non-pulmonary TB, and Smear-Negative Pulmonary Tuberculosis (SNPTB)
We show an overview of the prevalence of TB, which is higher in eastern Iran
Summary
Effective reduction of tuberculosis (TB) requires information on the distribution of TB incidence rate across time and location. TB remains a major public health problem in developing countries such as Iran In this country, the TB incidence rate stood at 16 persons per 100,000 in 2015, declining to 14 per 100,000 people in 2016 and 2017 [4,5,6]. A systematic review and meta-analysis in 2019 showed that health care workers residing in the northern and the western regions of the country had the highest prevalence of latent TB, i.e. carriers in good condition but with very small numbers of bacteria [9] In these patients, symptoms are not apparent as the infection is kept under control by the body’s immune system [10]. As the distribution of the disease varies in different parts of the country [20], efficient screening programmes by identifying the high-risk areas are required
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