Academic journal article Iranian Journal of Public Health

Spatio-Temporal Pattern of Tuberculosis in the Regions Supervised by Shiraz University of Medical Sciences 2006-2012

Academic journal article Iranian Journal of Public Health

Spatio-Temporal Pattern of Tuberculosis in the Regions Supervised by Shiraz University of Medical Sciences 2006-2012

Article excerpt


Tuberculosis (TB) is one of the oldest known human diseases caused by Mycobacterium tuberculosis and afflicts most limbs in almost one third of cases as well as lung tissues (1). This disease is caused by M. tuberculosis (and sometimes M. bovis and M. africanum) known as the Acid-Fast Bacilli or (AFB)(2). Nutrition and immunological factors, co-infection HIV, nephrogenic disease, silicosis, socio-economic factors, and seasonal changes have been stated to have an effect on the incidence of TB (1, 3). In addition, lack or inefficiency of the programs against TB has been effective in recurrence of the disease.

WHO reported in 2010 that there were 8.8 million new TB cases in the world. Besides, 1.4 million people die of TB each year among whom, 0.35 million deaths are HIV+, while 5.7 million TB patients have a successful treatment. This organization also reported that the incidence and prevalence rates of TB in Iran (per 100,000 peo- ple) were 19 and 27, respectively and 83% of the smear positive patients had successful treatment in 2008(4). New reports of TB control office in Iran indicated that the incidence and prevalence rates of the disease respectively reached 17 and 23 in 2011 (per 100,000 people). The prevalence rate would decrease to 30% by 2025 (5). The maximum incidence and prevalence rates were related to Sistan and Baluchistan and Golestan Provinces. The morbidity rate in women was 50% and 13% of the total affected patients had Afghan nationality. The TB incidence rate in Iran was mostly related to the 65 years and above age group, indicating success of TB control in Iran (5).

Geographical Information System (GIS) is a method used to find the effect of environmental and geographical factors on diseases and their aggregation and distribution locations. It also reduces the health costs related to diagnosis, treatment, and prevention. This software is utilized to apply spatial distribution in quantitative and qualitative maps and perform various analyses using descriptive data. Many infectious diseases and cancers which have unknown causes can be detected using this system, and global maps are designed to control and tackle them (6). WHO announced that GIS is appropriate for analyzing epidemiological data and revealing the processes and their mutual relationships, which are difficult to carry out through tabulation (7). Considering the world maps prepared by WHO in 2011, the eastern neighbors of Iran the western neighbor (Iraq affected by the crisis in the previous years), and northern neighbors (Central Asian countries that have numerous drug resistant TB patients) were among the regions with high and very high incidence rates of TB (50-99 and 100-299 in100000 people, respectively). These have made TB as a serious problem in our country (8, 9).

In the present study, Shiraz University of Medical Sciences was selected since it is located in Fars Province which is among the provinces with numerous Afghan immigrants (who are the most important sources of multi drug resistant TB (10). This study aimed to determine the spatial pattern of TB incidence and to evaluate TB control program indices.

Materials and Methods

The present ecological study was performed on TB patients in all the townships supervised by Shiraz University of Medical Sciences during 2006-2012, recorded by health centers using TB Register software. The necessary data and number of samples for each township were provided by Communicable Diseases Control department through coordination with Shiraz University of Medical Sciences. The population of cities between 2006 and 2012 was estimated using the data taken from Iran's 2007 census and the data on population growth size for each township. Because Fasa and Jahrom Universities of Medical Sciences are independent from Shiraz University of Medical Sciences, they have been marked white on the maps and their data were not used in the analyses. Since about 12-15 months are needed for clarification of treatment results, the latest data of TB Register program collected at the beginning of 2013 were used. …

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