Spatial analysis of tuberculosis in an Urban West African setting: is there evidence of clustering

To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering. In Greater Banjul, where 80% of all Gambian TB cases arise, all pa...

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Published inTropical medicine & international health Vol. 15; no. 6; pp. 664 - 672
Main Authors Touray, K, Adetifa, I.M, Jallow, A, Rigby, J, Jeffries, D, Cheung, Y.B, Donkor, S, Adegbola, R.A, Hill, P.C
Format Journal Article
LanguageEnglish
Published Oxford, UK Oxford, UK : Blackwell Publishing Ltd 01.06.2010
Blackwell Publishing Ltd
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Abstract To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering. In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents. Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region. There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes.
AbstractList SummaryObjectives To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering.Methods In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents.Results Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region.Conclusions There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes. Analyse spatiale de la tuberculose dans un milieu urbain de l'Afrique de l'Ouest: y a t-il une preuve de regroupement?Objectifs: Decrire les profils d'apparition de la tuberculose (TB) a Grand Banjul, en Gambie au moyen du Systeme d'Information Geographique (SIG) et des Statistiques de Scan Spatial (SatScan) et determiner s'il existe un important regroupement des cas de TB.Methodes: Dans la region etendue de Banjul ou 80% des cas de TB surviennent en Gambie, tous les cas de TB enregistres dans les cliniques du thorax entre mars 2007 et fevrier 2008 ont ete invites a participer a l'etude. Les caracteristiques demographiques et cliniques ainsi que les coordonnees SIG sur la residence de chaque cas TB consentant, ont ete enregistres. Une analyse statistique spatiale a ete utilisee pour identifier les grappes de TB avec une association purement spatio-temporelle chez les residents permanents.Resultats: sur 1145 cas de TB recrutes, 84% etaient des residents permanents dont 88% vivant dans 37 endroits avec une cartographie complete disponible jusqu'au qu'a l'echelle de la residence. Des taux importants de regroupement spatial et spatio-temporel, eleves et faibles ont ete recenses dans deux districts. Le regroupement avec un taux eleve le plus probable a la fois dans l'analyse purement spatiale et dans l'analyse spatio-temporelle retrospective etaient de la meme zone geographique. Un regroupement secondaire important a aussi ete identifie dans l'une des zones densement peuplees de la region 'etudiee.Conclusions: Il y a une preuve de regroupement important des cas de TB a Grand Banjul, en Gambie. L'utilisation systematique des techniques de detection des regroupements pour la surveillance reguliere de la TB en Gambie pourrait aider au deploiement efficace des ressources. Cependant, la detection passive des cas indique que la detection active des cas, basee sur la communaute et la surveillance des facteurs de risque permettrait de confirmer la presence de veritables regroupements et leurs causes. Analisis espacial de la tuberculosis en asentamientos urbanos de Africa del Oeste: hay evidencia de conglomerados?Objetivos: Describir el patron de TB en Greater Banjul, Gambia, utilizando un Sistema de Informacion Geografica y el software para analisis estadisticos SaTScan, y determinar si se da una conglomeracion significativa de los casos de TB.Metodos: En Greater Banjul, en donde surge un 80% de todos los casos de TB en Gambia, se invito a participar a todos los casos de TB registrados en las clinicas toracicas entre Marzo 2007 y Febrero 2008. Se registraron las caracteristicas demograficas, clinicas y coordenadas de GPS de la residencia de cada uno de los casos de TB que consintieron participar. Se utilizo el SaTScan para identificar conglomerados de tuberculosis puramente espaciales y conglomerados en espacio-tiempo entre los residentes permanentes.Resultados: De 1145 casos de TB reclutados, un 84% eran residentes permanentes con un 88% viviendo en 37 asentamientos con un mapa completo disponible a nivel de asentamiento. Se identificaron conglomerados espaciales y espacio-temporales con tasas de TB significativas tanto altas como bajas en dos distritos. Los conglomerados con mayor probabilidad de una tasa alta, tanto mediante un analisis puramente espacial como mediante un analisis espacio-tiempo retrospectivo, estaban en la misma area geografica. Tambien se identifico un conglomerado secundario en una de las areas con mayor densidad de poblacion del area de estudio.Conclusiones: Hay evidencia de una agregacion significativa de los casos de TB en Greater Banjul, Gambia. El uso sistematico de tecnicas para la deteccion de conglomerados en la vigilancia rutinaria de TB en Gambia podria contribuir a un uso mas efectivo de los recursos. Sin embargo, la deteccion pasiva de casos dicta que la deteccion activa de casos basada en la comunidad y las encuestas de factores de riesgo podrian ayudar a confirmar la presencia de conglomerados reales y de sus causas.
To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering. In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents. Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region. There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes.
To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering. In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents. Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region. There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes. [PUBLICATION ABSTRACT]
OBJECTIVESTo describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering. METHODSIn Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents. RESULTSOf 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region. CONCLUSIONSThere is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes.
Summary Objectives  To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering. Methods  In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co‐ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space–time clusters of tuberculosis among permanent residents. Results  Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high‐ and low‐rate spatial and space–time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space–time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region. Conclusions  There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community‐based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes. Analyse spatiale de la tuberculose dans un milieu urbain de l’Afrique de l’Ouest: y a t‐il une preuve de regroupement? Objectifs:  Décrire les profils d’apparition de la tuberculose (TB) à Grand Banjul, en Gambie au moyen du Système d’Information Géographique (SIG) et des Statistiques de Scan Spatial (SatScan) et déterminer s’il existe un important regroupement des cas de TB. Méthodes:  Dans la région étendue de Banjul où 80% des cas de TB surviennent en Gambie, tous les cas de TB enregistrés dans les cliniques du thorax entre mars 2007 et février 2008 ont été invités à participer à l’étude. Les caractéristiques démographiques et cliniques ainsi que les coordonnées SIG sur la résidence de chaque cas TB consentant, ont été enregistrés. Une analyse statistique spatiale a été utilisée pour identifier les grappes de TB avec une association purement spatio‐temporelle chez les résidents permanents. Résultats:  sur 1145 cas de TB recrutés, 84%étaient des résidents permanents dont 88% vivant dans 37 endroits avec une cartographie complète disponible jusqu’au qu’à l’échelle de la résidence. Des taux importants de regroupement spatial et spatio‐temporel, élevés et faibles ont été recensés dans deux districts. Le regroupement avec un taux élevé le plus probable à la fois dans l’analyse purement spatiale et dans l’analyse spatio‐temporelle rétrospective étaient de la même zone géographique. Un regroupement secondaire important a aussi été identifié dans l’une des zones densément peuplées de la région ‘étudiée. Conclusions:  Il y a une preuve de regroupement important des cas de TB à Grand Banjul, en Gambie. L’utilisation systématique des techniques de détection des regroupements pour la surveillance régulière de la TB en Gambie pourrait aider au déploiement efficace des ressources. Cependant, la détection passive des cas indique que la détection active des cas, basée sur la communauté et la surveillance des facteurs de risque permettrait de confirmer la présence de véritables regroupements et leurs causes. Análisis espacial de la tuberculosis en asentamientos urbanos de África del Oeste: hay evidencia de conglomerados? Objetivos:  Describir el patrón de TB en Greater Banjul, Gambia, utilizando un Sistema de Información Geográfica y el software para análisis estadísticos SaTScan, y determinar si se da una conglomeración significativa de los casos de TB. Métodos:  En Greater Banjul, en donde surge un 80% de todos los casos de TB en Gambia, se invitó a participar a todos los casos de TB registrados en las clínicas torácicas entre Marzo 2007 y Febrero 2008. Se registraron las características demográficas, clínicas y coordenadas de GPS de la residencia de cada uno de los casos de TB que consintieron participar. Se utilizó el SaTScan para identificar conglomerados de tuberculosis puramente espaciales y conglomerados en espacio‐tiempo entre los residentes permanentes. Resultados:  De 1145 casos de TB reclutados, un 84% eran residentes permanentes con un 88% viviendo en 37 asentamientos con un mapa completo disponible a nivel de asentamiento. Se identificaron conglomerados espaciales y espacio‐temporales con tasas de TB significativas tanto altas como bajas en dos distritos. Los conglomerados con mayor probabilidad de una tasa alta, tanto mediante un análisis puramente espacial como mediante un análisis espacio‐tiempo retrospectivo, estaban en la misma área geográfica. También se identificó un conglomerado secundario en una de las áreas con mayor densidad de población del área de estudio. Conclusiones:  Hay evidencia de una agregación significativa de los casos de TB en Greater Banjul, Gambia. El uso sistemático de técnicas para la detección de conglomerados en la vigilancia rutinaria de TB en Gambia podría contribuir a un uso más efectivo de los recursos. Sin embargo, la detección pasiva de casos dicta que la detección activa de casos basada en la comunidad y las encuestas de factores de riesgo podrían ayudar a confirmar la presencia de conglomerados reales y de sus causas.
To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering. In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents. Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region. There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes.
Author Donkor, S
Touray, K
Rigby, J
Adegbola, R.A
Hill, P.C
Adetifa, I.M
Jallow, A
Jeffries, D
Cheung, Y.B
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  fullname: Hill, P.C
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Issue 6
Keywords Infection
The Gambia
Geographic Information Systems
Urban environment
Tuberculosis
spatial analysis
Bacteriosis
Tropical medicine
clustering
Mycobacterial infection
Language English
License CC BY 4.0
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References 1998; 27
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Snippet To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics...
Summary Objectives  To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and...
OBJECTIVESTo describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan...
SummaryObjectives To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial...
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SubjectTerms Adolescent
Adult
analyse spatiale
Bacterial diseases
Biological and medical sciences
Child
Child, Preschool
Cluster Analysis
clustering
Female
Gambia
Gambia - epidemiology
Gambie
General aspects
Geographic Information Systems
Human bacterial diseases
Humans
Incidence
Infant
Infant, Newborn
Infectious diseases
Male
Medical sciences
Mycobacterium
Prospective Studies
regroupement
Risk
Sistemas de Información Geográfica
Space-Time Clustering
spatial analysis
Statistical methods
systèmes d’information géographique
The Gambia
tuberculose
Tuberculosis
Tuberculosis - epidemiology
Tuberculosis and atypical mycobacterial infections
tuberculosis; agregación; análisis espacial
Urban areas
Young Adult
Title Spatial analysis of tuberculosis in an Urban West African setting: is there evidence of clustering
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