Spatial distribution of extensively drug-resistant tuberculosis (XDR TB) patients in KwaZulu-Natal, South Africa

KwaZulu-Natal province, South Africa, has among the highest burden of XDR TB worldwide with the majority of cases occurring due to transmission. Poor access to health facilities can be a barrier to timely diagnosis and treatment of TB, which can contribute to ongoing transmission. We sought to deter...

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Vydáno v:PloS one Ročník 12; číslo 10; s. e0181797
Hlavní autoři: Kapwata, Thandi, Morris, Natashia, Campbell, Angela, Mthiyane, Thuli, Mpangase, Primrose, Nelson, Kristin N., Allana, Salim, Brust, James C. M., Moodley, Pravi, Mlisana, Koleka, Gandhi, Neel R., Shah, N. Sarita
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Public Library of Science 13.10.2017
Public Library of Science (PLoS)
Témata:
Acquired immune deficiency syndrome
Adult
Adults
AIDS
Care and treatment
Child
Children
Computer and Information Sciences
Disease transmission
Drug resistance
Engineering and Technology
Epidemics
Extensively Drug-Resistant Tuberculosis - epidemiology
Female
Geographical distribution
Geospatial data
Health aspects
Health care facilities
Health facilities
Health Facilities - statistics & numerical data
Hospital facilities
Humans
Male
Medical diagnosis
Medicine and Health Sciences
Metropolitan areas
Migration
Patients
People and places
Rural Population - statistics & numerical data
South Africa - epidemiology
Spatial Analysis
Spatial data
Spatial distribution
Travel
Tuberculosis
Tuberculosis patients
South Africa
Atlanta Georgia
Georgia
United States > US
ISSN:1932-6203, 1932-6203
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Shrnutí:KwaZulu-Natal province, South Africa, has among the highest burden of XDR TB worldwide with the majority of cases occurring due to transmission. Poor access to health facilities can be a barrier to timely diagnosis and treatment of TB, which can contribute to ongoing transmission. We sought to determine the geographic distribution of XDR TB patients and proximity to health facilities in KwaZulu-Natal. We recruited adults and children with XDR TB diagnosed in KwaZulu-Natal. We calculated distance and time from participants' home to the closest hospital or clinic, as well as to the actual facility that diagnosed XDR TB, using tools within ArcGIS Network analyst. Speed of travel was assigned to road classes based on Department of Transport regulations. Results were compared to guidelines for the provision of social facilities in South Africa: 5km to a clinic and 30km to a hospital. During 2011-2014, 1027 new XDR TB cases were diagnosed throughout all 11 districts of KwaZulu-Natal, of whom 404 (39%) were enrolled and had geospatial data collected. Participants would have had to travel a mean distance of 2.9 km (CI 95%: 1.8-4.1) to the nearest clinic and 17.6 km (CI 95%: 11.4-23.8) to the nearest hospital. Actual distances that participants travelled to the health facility that diagnosed XDR TB ranged from <10 km (n = 143, 36%) to >50 km (n = 109, 27%), with a mean of 69 km. The majority (77%) of participants travelled farther than the recommended distance to a clinic (5 km) and 39% travelled farther than the recommended distance to a hospital (30 km). Nearly half (46%) of participants were diagnosed at a health facility in eThekwini district, of whom, 36% resided outside the Durban metropolitan area. XDR TB cases are widely distributed throughout KwaZulu-Natal province with a denser focus in eThekwini district. Patients travelled long distances to the health facility where they were diagnosed with XDR TB, suggesting a potential role for migration or transportation in the XDR TB epidemic.
Bibliografie:ObjectType-Article-1
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0181797