Spatial distribution of Mycobacterium Tuberculosis in metropolitan Harare, Zimbabwe

The contribution of high tuberculosis (TB) transmission pockets in propagating area-wide transmission has not been adequately described in Zimbabwe. This study aimed to describe the presence of hotspot transmission of TB cases in Harare city from 2011 to 2012 using geospatial techniques. Anonymised...

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Bibliographic Details
Published in:	PloS one Vol. 15; no. 4; p. e0231637
Main Authors:	Chirenda, Joconiah, Gwitira, Isaiah, Warren, Robin M, Sampson, Samantha L, Murwira, Amon, Masimirembwa, Collen, Mateveke, Kudzanai M, Duri, Cremence, Chonzi, Prosper, Rusakaniko, Simbarashe, Streicher, Elizabeth M
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 21-04-2020 Public Library of Science (PLoS)
Subjects:	Adolescent Adult Biology and Life Sciences Child Child, Preschool Cities Clustering Computer and Information Sciences Councils Disease hot spots Disease transmission Disease Transmission, Infectious Earth Sciences Environmental science Epidemics Excellence Female Geographic Information Systems Geography Health care facilities Health sciences Health Services Accessibility HIV HIV - pathogenicity HIV Infections - complications HIV Infections - epidemiology HIV Infections - microbiology HIV Infections - virology Hospitals Human immunodeficiency virus Humans Infections Infectious diseases Male Medical research Medicine Medicine and Health Sciences Middle Aged Molecular biology Mycobacterium tuberculosis - pathogenicity Patients People and Places Population Remote sensing Social services Spatial Analysis Spatial distribution Suburban areas Suburbs Tuberculosis Tuberculosis - complications Tuberculosis - epidemiology Tuberculosis - microbiology Tuberculosis - virology Urban areas Urban Population Urban populations Viruses Young Adult Zimbabwe - epidemiology Zimbabwe South Africa Southern Africa
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Summary:	The contribution of high tuberculosis (TB) transmission pockets in propagating area-wide transmission has not been adequately described in Zimbabwe. This study aimed to describe the presence of hotspot transmission of TB cases in Harare city from 2011 to 2012 using geospatial techniques. Anonymised TB patient data stored in an electronic database at Harare City Health department was analysed using geospatial methods. Confirmed TB cases were mapped using geographic information system (GIS). Global Moran's I and Anselin Local Moran's I (LISA) were used to assess clustering and the local Getis-Ord Gi* was used to estimate hotspot phenomenon of TB cases in Harare City for the period between 2011 and 2012. A total of 12,702 TB cases were accessed and mapped on the Harare City map. In both 2011 and 2012, ninety (90%) of cases were new and had a high human immunodeficiency virus (HIV)/TB co-infection rate of 72% across all suburbs. Tuberculosis prevalence was highest in the Southern district in both 2011 and 2012. There were pockets of spatial distribution of TB prevalence across West South West, Southern, Western, South Western and Eastern health districts. TB hot spot occurrence was restricted to the West South West, parts of South Western, Western health districts. West South West district had an increased peri-urban population with inadequate social services including health facilities. These conditions were conducive for increased intensity of TB occurrence, a probable indication of high transmission especially in the presence of high HIV co-infection. Increased TB transmission was limited to a health district with high informal internal migrants with limited health services in Harare City. To minimise spread of TB into greater Harare, there is need to improve access to TB services in the peri-urban areas.
Bibliography:	Competing Interests: The authors have declared that no competing interests exist. These authors also contributed equally to this work.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0231637