Study of spatial distribution of human tuberculosis in Zambia's Lundazi District

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Cheelo, Victor
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University of Zambia
In the last decade of the 20th Century, human Tuberculosis (TB) has re-emerged with a significant impact on global public health. About 9.4 million new cases of human TB are recorded annually with approximately 1.7 million deaths, affecting mainly young adults in their most productive years. The objective of the present study was to describe the spatial distribution of TB in human population of Zambia’s Lundazi district. This was a cross sectional study involving trace back of 60 TB patient participants of Lundazi district. Geographical Positioning System (GPS) coordinates were captured for the 60 sampled participants from Chitungulu, Kanyanga and Mwasemphangwe Rural Community TB diagnostic centers. This was accompanied by a semi structured questionnaire which was administered by trained interviewers to obtain information on risk factors of TB in the district. The results obtained from this study through the use of geographical spatial referencing and mapping of human TB has demonstrated geographical clustering of human TB cases. The spatial analysis of the hotspots suggest that there were statistically significant hotspots of TB (p < 0.0000) and showed the existence of TB clusters in all the three diagnostic centers of the district. These hot spots were located in areas that were populated, supporting an association between population density and increased risk of TB. The degree of clustering of TB cases in the TB diagnostic centers was confirmed by Moran’s I (P < 0.0000, Z = 7.41). Regarding the TB risk factors investigated, the disease was associated with (i) smoking and alcohol consumption i.e. the odds of developing TB was high among those respondents who were both drinking alcohol and smoking tobacco (OR = 4.6, p = 0.04, 95% CI, 1.019 - 21.485) and (ii) cigarette smoking (OR = 1.12, P = 0.020, 95% CI, 1.017 - 1.235). The ANOVA analysis also demonstrated that only History of Previous contact with TB patients (p < 0.000) and Smoking (p < 0.000), made a significant contribution to prediction. Overall, the study has confirmed, for the first time, the existence of human TB clustering and the presence of hot spots in Lundazi district. From this study it is recommended that public health implication in relation to spatial distribution of TB, social interaction patterns, demographical factors and other multiplicative factors for transmission (i.e. co-infection with HIV) need to be considered when formulating policy action and plans
Thesis(MSc)-University of Zambia,2015