Space-Time Clustering Characteristics of Tuberculosis in Khyber Pakhtunkhwa Province, Pakistan, 2015–2019

Ullah, Sami; Daud, Hanita; Dass, Sarat C.; Fanaee-T, Hadi; Kausarian, Husnul; Khalil, Alamgir

doi:10.3390/ijerph17041413

Cited by 10 publications

(6 citation statements)

References 25 publications

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“…These countries are main sources of TB, which affect TB transmission in Iran [ 18 ]. A spatio-temporal study of TB in Pakistan [ 32 ] revealed northern and western parts of country as high-risk clusters for TB. Western areas of this country share long borders with eastern and south-eastern Iran.…”

Section: Discussionmentioning

confidence: 99%

“…A TB study in Pakistan [ 32 ] conducted by spatial scan statistics identified spatio-temporal clustering with high-risk clusters across the country during 2015–2019, particularly in the northern and western parts of the study area. Another study, assessing spatial and temporal pattern of TB in the 75 municipalities in the Northeast of Brazil during 2001 to 2016 by empirical Bayesian and Moran statistic [ 23 ], noted an increased trend of TB in patients under 40 years of age.…”

Section: Introductionmentioning

confidence: 99%

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Spatio-temporal epidemiology of the tuberculosis incidence rate in Iran 2008 to 2018

et al. 2021

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Background Effective 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. Methods This 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. Results The 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. Conclusion The 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spatio-temporal epidemiology of the tuberculosis incidence rate in Iran 2008 to 2018

et al. 2021

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“…One of the statistical methods for detecting spatial/geographical clusters of a disease is the Spatial Scan Statistic (Kulldorff, 1997), which is a freely available software called SaTScan™ (https://www.satscan.org/). It is widely used in public health and epidemiology (Amin et al, 2019;Omodior et al, 2019;Souza et al, 2019;Amin & Rivera, 2020;Desjardins et al, 2020;Ullah et al, 2020). There are several other cluster analysis algorithms in the literature, such as DBSCAN (Ester et al, 1996).…”

Section: Introductionmentioning

confidence: 99%

Spatial cluster analysis of COVID-19 in Malaysia (Mar-Sep, 2020)

et al. 2021

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Coronavirus disease 2019 (COVID-19) is the current worldwide pandemic as declared by the World Health Organization (WHO) in March 2020. Being part of the ongoing global pandemic, Malaysia has recorded a total of 8639 COVID-19 cases and 121 deaths as of 30th June 2020. This study aims to detect spatial clusters of COVID-19 in Malaysia using the Spatial Scan Statistic (SaTScan™) to guide control authorities on prioritizing locations for targeted interventions. The spatial analyses were conducted on a monthly basis at the state-level from March to September 2020. The results show that the most likely cluster of COVID-19 occurred in West Malaysia repeatedly from March to June, covering three counties (two federal territories and one neighbouring state) and moved to East Malaysia in July covering two other counties. The most likely cluster shows a tendency of having moved from the western part to the eastern part of the country. These results provide information that can be used for the evidence- based interventions to control the spread of COVID-19 in Malaysia.

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“…All study sites were linked to a mental health facility for patient referral. As the first point of contact, the DOTS facilitator conducted the initial screening using the two-item Patient Health Questionnaire-2 (PHQ-2) by Kroenke et al 24 Patients with a score of 2 or less entered the facility's usual care pathway, whereas those with a score of more than 2 were further screened using the nine-item Patient Health Questionnaire-9 (PHQ-9) by Kroenke et al 25 Patients were further managed based on their PHQ-9 screening scores: no depression (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19) and severe (20)(21)(22)(23)(24)(25)(26)(27) (Figure 1).…”

Section: Care Pathwaymentioning

confidence: 99%

Depression care integration in tuberculosis services: A feasibility assessment in Pakistan

Afaq,

Ayub,

Faisal

et al. 2024

Health Expectations

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BackgroundThe co‐occurrence of depression among tuberculosis (TB) patients is a critical issue, contributing to poor treatment outcomes, prolonged hospitalisations and increased healthcare expenses.ObjectiveThe objective of this study was to assess the feasibility of delivering a co‐designed depression care pathway within TB services in Pakistan.DesignMixed‐method study.Setting and ParticipantsRoutine depression screening for TB patients was conducted at three TB facilities in Peshawar, Pakistan, encompassing primary, secondary and tertiary care settings. All patients aged 18 or above (male and female) attending the three TB facilities between November 2021 and February 2022 were included in the study using the consecutive sampling technique.ResultsA total of 301 people with confirmed TB, within the past 4 weeks, visited the three TB care facilities; 191/301 patients were screened for depression. Approximately 35% of the 191 TB patients screened positive for depression, with varying severity levels. Qualitative findings highlighted the acceptability of integrated depression care, emphasising the importance of open communication and empathetic attitudes. Barriers to integration include stigma, logistical challenges, patient noncompliance and cost burdens. Facilitators included the empathetic attitude of healthcare providers and the availability of mental health services within the same facility.ConclusionThere is a high burden of depression in patients with TB, highlighting the pressing need for mental health support in this population. Acceptability of integrated care was evident, with factors such as co‐located mental health services, training healthcare providers and provider empathetic attitudes playing a crucial role. Further research is required to evaluate the effectiveness of the integrated TB‐depression screening systems towards improved health outcomes, implementation, scalability and impact on the broader healthcare system.Patient and Public ContributionTo create a more inclusive and comprehensive TB and depression care pathway, we gathered input from both service providers and service users (TB patients, their carers). Reflective meetings with community leaders, social activists and health professionals from various sectors were also conducted during pathway delivery to get their insights. Power, gender and age imbalances were addressed by encouraging participation of patients and carers across gender and age groups. This approach ensured that the perspectives of all stakeholders were considered in the development of the care pathway.

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Space-Time Clustering Characteristics of Tuberculosis in Khyber Pakhtunkhwa Province, Pakistan, 2015–2019

Cited by 10 publications

References 25 publications

Spatio-temporal epidemiology of the tuberculosis incidence rate in Iran 2008 to 2018

Spatio-temporal epidemiology of the tuberculosis incidence rate in Iran 2008 to 2018

Spatial cluster analysis of COVID-19 in Malaysia (Mar-Sep, 2020)

Depression care integration in tuberculosis services: A feasibility assessment in Pakistan

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