Spatial distribution of tuberculosis in a rural region of Western Province, Papua New Guinea
DOI:
https://doi.org/10.5365/wpsar.2019.10.2.001Abstract
Introduction: There is a high burden of tuberculosis (TB) in the Western Province, Papua New Guinea. This study aims to describe the spatial distribution of TB in the Balimo District Hospital (BDH) catchment area to identify TB patient clusters and factors associated with high rates of TB.
Methods: Information about TB patients was obtained from the BDH TB patient register for the period 26 April 2013 to 25 February 2017. The locations of TB patients were mapped, and the spatial scan statistic was used to identify high- and low-rate TB clusters in the BDH catchment area.
Results: A total of 1568 patients were mapped with most being from the Balimo Urban (n = 252), Gogodala Rural (n = 1010) and Bamu Rural (n = 295) local level government (LLG) areas. In the Gogodala region (Balimo Urban and Gogodala Rural LLGs), high-rate clusters occurred closer to the town of Balimo, while low-rate clusters were located in more remote regions. In addition, closer proximity to Balimo was a predictor of high-rate clustering.
Discussion: There is heterogeneity in the distribution of TB in the Balimo region. Active case-finding activities indicated potential underdiagnosis of TB and the possibility of associated missed diagnoses of TB. The large BDH catchment area emphasizes the importance of the hospital in managing TB in this rural region.
References
Aia P, Wangchuk L, Morishita F, Kisomb J, Yasi R, Kal M, et al. Epidemiology of tuberculosis in Papua New Guinea: analysis of case notification data and treatment-outcome data, 2008-2016. Western Pacific Surveillance and Response. 2018;9(2).
Diefenbach-Elstob T, Graves P, Dowi R, Gula B, Plummer D, McBryde E, et al. The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea. Tropical Medicine & International Health. 2018;23(9):1022-32.
Department of Health. Papua New Guinea: national tuberculosis management protocol. Port Moresby, Papua New Guinea: Department of Health; 2011 [cited 2017 31 October]. Available from: http://www.adi.org.au/wp-content/uploads/2016/11/National-Tuberculosis-Management-Protocol-PNG-2011.pdf
World Health Organization. Definitions and reporting framework for tuberculosis - 2013 revision (updated December 2014). Geneva (Switzerland): World Health Organization; 2013 [cited 2018 18 January]. Available from: http://apps.who.int/iris/bitstream/10665/79199/1/9789241505345_eng.pdf?ua=1
Papua New Guinea Electoral Commission. Election commencing 23 June 2012: polling schedule for Middle Fly electorate. Papua New Guinea Electoral Commission: Port Moresby (Papua New Guinea); 2012 [accessed 4 March 2018]. Available from: https://garamut.files.wordpress.com/2012/06/western_middle-fly-schedule.pdf
Papua New Guinea Electoral Commission. Election commencing 20th April 2017: polling schedule for Middle Fly Open electorate. Papua New Guinea Electoral Commission: Port Moresby (Papua New Guinea); 2017 [accessed 4 March 2018]. Available from: http://www.pngec.gov.pg/docs/default-source/default-document-library/polling-schedule-v6.pdf?sfvrsn=2
National Statistical Office. 2011 national population & housing census: ward population profile - southern region. Port Moresby, Papua New Guinea: National Statistical Office; 2014 [cited 2017 31 October]. Available from: http://www.nso.gov.pg/index.php/document-library?view=download&fileId=64
GeoMidpoint.com. Geographic midpoint calculator. 2017 [accessed 11 November 2017]. Available from: http://www.geomidpoint.com/
Kulldorff M, Information Management Services, Inc.,. SaTScanTM v8.0: software for the spatial and space-time scan statistics. Boston (USA): SaTScanTM; 2009 [cited 2017 4 July]. Available from: http://www.satscan.org/
Kulldorff M. A spatial scan statistic. Communication in Statistics – Theory and Methods. 1997;26(6):1481-96.
Kulldorff M. SaTScanTM user guide for version 9.4. Boston (USA): SaTScanTM; 2015 [cited 2018 10 May]. Available from: http://www.satscan.org
Han J, Zhu L, Kulldorff M, Hostovich S, Stinchcomb DG, Tatalovich Z, et al. Using Gini coefficient to determining optimal cluster reporting sizes for spatial scan statistics. International Journal of Health Geographics. 2016;15:27.
National Hurricane Center. Latitude/longitude distance calculator. US Dept of Commerce - National Oceanic and Atmospheric Administration: Miami (USA); n.d. [accessed 7 December 2018].
Guernier V, Diefenbach-Elstob T, Pelowa D, Pollard S, Burgess G, McBryde ES, et al. Molecular diagnosis of suspected tuberculosis from archived smear slides from the Balimo region, Papua New Guinea. International Journal of Infectious Diseases. 2018;67:75-81.
Dangisso MH, Datiko DG, Lindtjørn B. Spatio-temporal analysis of smear-positive tuberculosis in the Sidama Zone, Southern Ethiopia. PLoS ONE. 2015;10(6):e0126369.
Robel Y, Lemessa F, Hirpa S, Abraham A, Klinkenberg E. Determinants of delayed care seeking for TB suggestive symptoms in Seru district, Oromiya region, Ethiopia: a community based unmatched case-control study. BMC Infectious Diseases. 2017;17:292.
Babatunde OI, Bismark EC, Amaechi NE, Gabriel EI, Olanike A-UR. Determinants of treatment delays among pulmonary tuberculosis patients in Enugu Metropolis, South-East, Nigeria. Health. 2015;7:1506-16.
Demissie M, Lindtjørn B, Berhane Y. Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health. 2002;2:23.
Antunes JLF, Waldman EA. The impact of AIDS, immigration and housing overcrowding on tuberculosis deaths in São Paulo, Brazil, 1994–1998. Social Science & Medicine. 2001;52(7):1071-80.
Oppong JR, Mayer J, Oren E. The global health threat of African urban slums: the example of urban tuberculosis. African Geographical Review. 2015;34(2):182-95.
Diefenbach-Elstob T, Plummer D, Dowi R, Wamagi S, Gula B, Siwaeya K, et al. The social determinants of tuberculosis treatment adherence in a remote region of Papua New Guinea. BMC Public Health. 2017;17:70.
Ongugo K, Hall J, Attia J. Implementing tuberculosis control in Papua New Guinea: a clash of culture and science? Journal of Community Health. 2011;36:423-30.
Datiko DG, Yassin MA, Theobald SJ, Blok L, Suvanand S, Creswell J, et al. Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study. BMJ Global Health. 2017;2(4):e000390.
Dangisso MH, Datiko DG, Lindtjørn B. Accessibility to tuberculosis control services and tuberculosis programme performance in southern Ethiopia. Global Health Action. 2015;8:29443.
Parija D, Patra TK, Kumar AMV, Swain BK, Satyanarayana S, Sreenivas A, et al. Impact of awareness drives and community-based active tuberculosis case finding in Odisha, India. The International Journal of Tuberculosis and Lung Disease. 2014;18(9):1105-7.
Yassin MA, Datiko DG, Tulloch O, Markos P, Aschalew M, Shargie EB, et al. Innovative community-based approaches doubled tuberculosis case notification and improve treatment outcome in southern Ethiopia. PLoS ONE. 2013;8(5):e63174.
McBryde E. Evaluation of risks of tuberculosis in Western Province Papua New Guinea. Barton (Australia): Department of Foreign Affairs and Trade; 2012 [cited 2017 31 October]. Available from: https://www.burnet.edu.au/system/publication/file/3606/2012_Evaluation_of_Risks_of_Tuberculosis_in_Western_Province_PNG.pdf
Andrews JR, Morrow C, Walensky RP, Wood R. Integrating social contact and environmental data in evaluating tuberculosis transmission in a South African township. The Journal of Infectious Diseases. 2014;210(4):597-603.
McElnay C, Thornley C, Armstrong R. A community and workplace outbreak of tuberculosis in Hawke's Bay in 2002. The New Zealand Medical Journal. 2004;117(1200).
