Dataset Information

Spatiotemporal distribution and predictors of tuberculosis incidence in Morocco.

ABSTRACT: BACKGROUND:Tuberculosis (TB) is a major health problem in Morocco. This study aims at examining trends in TB in Morocco and identifying TB spatial clusters and TB-associated predictors. METHOD:Country-level surveillance data was exploited. Kendall's correlation test was used to examine trends and an exploratory spatial data analysis was conducted to assess the global and local patterns of spatial autocorrelation in TB rates (Moran's I and local indicator of spatial association [LISA]) at the prefecture/province level. Covariates including living in a prefecture versus living in a province, annual rainfall, annual mean temperature, population density, and AIDS incidence were controlled. An ordinary least squares regression was thus performed and both spatial dependence and heteroscedasticity were assessed. RESULTS:A decrease in TB incidence rate was seen between 1995 and 2014 (Kendall's tau b?=?-?0.72; P?

SUBMITTER: Sadeq M

PROVIDER: S-EPMC5991459 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Spatiotemporal distribution and predictors of tuberculosis incidence in Morocco.

Sadeq Mina M Bourkadi Jamal Eddine JE

Infectious diseases of poverty 20180607 1

<h4>Background</h4>Tuberculosis (TB) is a major health problem in Morocco. This study aims at examining trends in TB in Morocco and identifying TB spatial clusters and TB-associated predictors.<h4>Method</h4>Country-level surveillance data was exploited. Kendall's correlation test was used to examine trends and an exploratory spatial data analysis was conducted to assess the global and local patterns of spatial autocorrelation in TB rates (Moran's I and local indicator of spatial association [LI ...[more]

PMID: 29875019

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Project description:Bovine tuberculosis (BTB) is an endemic zoonosis in Morocco caused by Mycobacterium bovis, which infects many domestic animals and is transmitted to humans through consumption of raw milk or from contact with infected animals. The prevalence of BTB in Moroccan cattle is estimated at 18%, and 33% at the individual and the herd level respectively, but the human M. bovis burden needs further clarification. The current control strategy based on test and slaughter should be improved through local context adaptation taking into account a suitable compensation in order to reduce BTB prevalence in Morocco and decrease the disease burden in humans and animals. We established a simple compartmental deterministic mathematical model for BTB transmission in cattle and humans to provide a general understanding of BTB, in particular regarding transmission to humans. Differential equations were used to model the different pathways between the compartments for cattle and humans. Scenarios of test and slaughter were simulated to determine the effects of varying the proportion of tested animals (p) on the time to elimination of BTB (individual animal prevalence of less than one in a thousand) in cattle and humans. The time to freedom from disease ranged from 75 years for p = 20% to 12 years for p = 100%. For p > 60% the time to elimination was less than 20 years. The cumulated cost was largely stable: for p values higher than 40%, cost ranged from 1.47 to 1.60 billion euros with a time frame of 12 to 32 years to reach freedom from disease. The model simulations also suggest that using a 2mm cut off instead of a 4mm cut off in the Single Intradermal Comparative Cervical Tuberculin skin test (SICCT) would result in cheaper and quicker elimination programs. This analysis informs Moroccan bovine tuberculosis control policy regarding time frame, range of cost and levels of intervention. However, further research is needed to clarify the national human-bovine tuberculosis ratio in Morocco.

Project description:ObjectivesXinjiang is one of the high TB burden provinces of China. A spatial analysis was conducted using geographical information system (GIS) technology to improve the understanding of geographic variation of the pulmonary TB occurrence in Xinjiang, its predictors, and to search for targeted interventions.MethodsNumbers of reported pulmonary TB cases were collected at county/district level from TB surveillance system database. Population data were extracted from Xinjiang Statistical Yearbook (2006~2014). Spatial autocorrelation (or dependency) was assessed using global Moran's I statistic. Anselin's local Moran's I and local Getis-Ord statistics were used to detect local spatial clusters. Ordinary least squares (OLS) regression, spatial lag model (SLM) and geographically-weighted regression (GWR) models were used to explore the socio-demographic predictors of pulmonary TB incidence from global and local perspectives. SPSS17.0, ArcGIS10.2.2, and GeoDA software were used for data analysis.ResultsIncidence of sputum smear positive (SS+) TB and new SS+TB showed a declining trend from 2005 to 2013. Pulmonary TB incidence showed a declining trend from 2005 to 2010 and a rising trend since 2011 mainly caused by the rising trend of sputum smear negative (SS-) TB incidence (p<0.0001). Spatial autocorrelation analysis showed the presence of positive spatial autocorrelation for pulmonary TB incidence, SS+TB incidence and SS-TB incidence from 2005 to 2013 (P <0.0001). The Anselin's Local Moran's I identified the "hotspots" which were consistently located in the southwest regions composed of 20 to 28 districts, and the "coldspots" which were consistently located in the north central regions consisting of 21 to 27 districts. Analysis with the Getis-Ord Gi* statistic expanded the scope of "hotspots" and "coldspots" with different intensity; 30 county/districts clustered as "hotspots", while 47 county/districts clustered as "coldspots". OLS regression model included the "proportion of minorities" and the "per capita GDP" as explanatory variables that explained 64% the variation in pulmonary TB incidence (adjR2 = 0.64). The SLM model improved the fit of the OLS model with a decrease in AIC value from 883 to 864, suggesting "proportion of minorities" to be the only statistically significant predictor. GWR model also improved the fitness of regression (adj R2 = 0.68, AIC = 871), which revealed that "proportion of minorities" was a strong predictor in the south central regions while "per capita GDP" was a strong predictor for the southwest regions.ConclusionThe SS+TB incidence of Xinjiang had a decreasing trend during 2005-2013, but it still remained higher than the national average in China. Spatial analysis showed significant spatial autocorrelation in pulmonary TB incidence. Cluster analysis detected two clusters-the "hotspots", which were consistently located in the southwest regions, and the "coldspots", which were consistently located in the north central regions. The exploration of socio-demographic predictors identified the "proportion of minorities" and the "per capita GDP" as predictors and may help to guide TB control programs and targeting intervention.

Dataset Information

Spatiotemporal distribution and predictors of tuberculosis incidence in Morocco.

Publications

Spatiotemporal distribution and predictors of tuberculosis incidence in Morocco.

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