The detected spatial-temporal clusters of HFMD in Shandong Province during 2007 to 2011, and the distribution of HFMD pathogens within these clusters.

<p>Each pie shows the proportion of different HFMD pathogen for each spatial-temporal cluster, but no pathogen data in 2007.</p

Annual incidence rates of HFMD in 0–5 years old children (/100,000) per county in Shandong Province, 2007–2011.

<p>Annual incidence rates of HFMD in 0–5 years old children (/100,000) per county in Shandong Province, 2007–2011.</p

Association between Multidrug-Resistant Tuberculosis and Risk Factors in China: Applying Partial Least Squares Path Modeling

<div><p>Background</p><p>Multidrug-resistant tuberculosis (MDR-TB) resulting from various factors has raised serious public health concerns worldwide. Identifying the ecological risk factors associated with MDR-TB is critical to its prevention and control. This study aimed to explore the association between the development of MDR-TB and the risk factors at the group-level (ecological risk factors) in China.</p><p>Methods</p><p>Data on MDR-TB in 120 counties were obtained from the National Tuberculosis Information Management System, and data on risk-factor variables were extracted from the Health Statistical Yearbook, provincial databases, and the meteorological bureau of each province (municipality). Partial Least Square Path Modeling was used to detect the associations.</p><p>Results</p><p>The median proportion of MDR-TB in new TB cases was 3.96% (range, 0–39.39%). Six latent factors were extracted from the ecological risk factors, which explained 27.60% of the total variance overall in the prevalence of MDR-TB. Based on the results of PLS-PM, TB prevention, health resources, health services, TB treatment, TB detection, geography and climate factors were all associated with the risk of MDR-TB, but socioeconomic factors were not significant.</p><p>Conclusions</p><p>The development of MDR-TB was influenced by TB prevention, health resources, health services, TB treatment, TB detection, geography and climate factors. Such information may help us to establish appropriate public health intervention strategies to prevent and control MDR-TB and yield benefits to the entire public health system in China.</p></div

Initial PLS-PM of the prevalence of MDR-TB and related risk factors.

<p>Initial PLS-PM of the prevalence of MDR-TB and related risk factors.</p

Social-demographic characteristics of HFMD cases and the pathogen types of some cases in Shandong Province, 2007–2011.

<p>Social-demographic characteristics of HFMD cases and the pathogen types of some cases in Shandong Province, 2007–2011.</p

The results of the spatial autocorrelation test on HFMD cases in Shandong Province, 2007–2011.

<p>The results of the spatial autocorrelation test on HFMD cases in Shandong Province, 2007–2011.</p

The location of study area, Shandong Province in China.

<p>The location of study area, Shandong Province in China.</p

The most likely high risk clusters of HFMD cases detected using the purely spatial analysis.

<p>The most likely high risk clusters of HFMD cases detected using the purely spatial analysis.</p

The spatial-temporal high risk clusters of HFMD cases detected using Space-Time Permutation model, 2007–2011.

#<p>:‘1’ represents ‘Most likely cluster’; ‘2–7’ represent six ‘Secondary clusters’.</p

Monthly distribution of HFMD cases (0–5 years), 2007–2011.

<p>Monthly distribution of HFMD cases (0–5 years), 2007–2011.</p