A multivariable fixed effects Poisson regression model of socio-economic and demographic factors influencing district-level incidence of multidrug resistant tuberculosis per 100,000 population in northwest Ethiopia, 2010 to 2015.

<p>A multivariable fixed effects Poisson regression model of socio-economic and demographic factors influencing district-level incidence of multidrug resistant tuberculosis per 100,000 population in northwest Ethiopia, 2010 to 2015.</p

Frequency of HIV, HBV and HCV infections with respect to donation year among blood donors at the North Gondar district Blood Bank, northwest Ethiopia.

<p>Frequency of HIV, HBV and HCV infections with respect to donation year among blood donors at the North Gondar district Blood Bank, northwest Ethiopia.</p

Anti-TB therapy and diseases related characteristics of TB patients, North Gondar zone, Northwest Ethiopia, May 2013.

<p>CPT = cotrimoxazole preventive therapy, EPTB = Extra pulmonary TB, PTB-SM+ = Smear positive pulmonary TB, PTB-SM− = Smear negative pulmonary TB, OI = Opportunistic Infections.</p

Sero-prevalence of HBV infection according to socio-demographic characteristics of blood donors at the North Gondar District Blood Bank, northwest Ethiopia.

<p>Sero-prevalence of HBV infection according to socio-demographic characteristics of blood donors at the North Gondar District Blood Bank, northwest Ethiopia.</p

Map of the study area, northwest Ethiopia.

<p>Map of the study area, northwest Ethiopia.</p

Poisson regression model for the association of socio-economic, demographic, housing condition and spatially structured random effect at the district level with cases of multidrug-resistant tuberculosis in northwest Ethiopia, 2010 to 2015.

<p>Poisson regression model for the association of socio-economic, demographic, housing condition and spatially structured random effect at the district level with cases of multidrug-resistant tuberculosis in northwest Ethiopia, 2010 to 2015.</p

Spatial patterns of multidrug resistant tuberculosis and relationships to socio-economic, demographic and household factors in northwest Ethiopia

<div><p>Background</p><p>Understanding the geographical distribution of multidrug-resistant tuberculosis (MDR-TB) in high TB burden countries such as Ethiopia is crucial for effective control of TB epidemics in these countries, and thus globally. We present the first spatial analysis of multidrug resistant tuberculosis, and its relationship to socio-economic, demographic and household factors in northwest Ethiopia.</p><p>Methods</p><p>An ecological study was conducted using data on patients diagnosed with MDR-TB at the University of Gondar Hospital MDR-TB treatment centre, for the period 2010 to 2015. District level population data were extracted from the Ethiopia National and Regional Census Report. Spatial autocorrelation was explored using Moran’s I statistic, Local Indicators of Spatial Association (LISA), and the Getis-Ord statistics. A multivariate Poisson regression model was developed with a conditional autoregressive (CAR) prior structure, and with posterior parameters estimated using a Bayesian Markov chain Monte Carlo (MCMC) simulation approach with Gibbs sampling, in WinBUGS.</p><p>Results</p><p>A total of 264 MDR-TB patients were included in the analysis. The overall crude incidence rate of MDR-TB for the six-year period was 3.0 cases per 100,000 population. The highest incidence rate was observed in Metema (21 cases per 100,000 population) and Humera (18 cases per 100,000 population) districts; whereas nine districts had zero cases. Spatial clustering of MDR-TB was observed in districts located in the Ethiopia-Sudan and Ethiopia-Eritrea border regions, where large numbers of seasonal migrants live. Spatial clustering of MDR-TB was positively associated with urbanization (RR: 1.02; 95%CI: 1.01, 1.04) and the percentage of men (RR: 1.58; 95% CI: 1.26, 1.99) in the districts; after accounting for these factors there was no residual spatial clustering.</p><p>Conclusion</p><p>Spatial clustering of MDR-TB, fully explained by demographic factors (urbanization and percent male), was detected in the border regions of northwest Ethiopia, in locations where seasonal migrants live and work. Cross-border initiatives including options for mobile TB treatment and follow up are important for the effective control of MDR-TB in the region.</p></div

Choropleth maps showing the geographical distribution of the percentage of the district (a) who are male and (b) who live in urban communities across northwest Ethiopia, 2010 to 2015.

<p>Choropleth maps showing the geographical distribution of the percentage of the district (a) who are male and (b) who live in urban communities across northwest Ethiopia, 2010 to 2015.</p

Demographic characteristics of blood donors at the North Gondar District Blood Bank, northwest Ethiopia, 2010 to 2012.

<p>Demographic characteristics of blood donors at the North Gondar District Blood Bank, northwest Ethiopia, 2010 to 2012.</p

Reasons of anti-TB pills missing, North Gondar zone, Northwest Ethiopia, May 2013.

<p>Reasons of anti-TB pills missing, North Gondar zone, Northwest Ethiopia, May 2013.</p