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Changes in the geographical distribution of tuberculosis patients in Veracruz, Mexico, after reinforcement of a tuberculosis control programme
Author(s) -
Jacobson Lara M.,
Lourdes GarciaGarcia Ma.,
HernandezAvila Juan Eugenio,
CanoArellano Bulmaro,
Small Peter M.,
SifuentesOsornio Jose,
PoncedeLeon Alfredo
Publication year - 2005
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2005.01392.x
Subject(s) - tuberculosis , medicine , transmission (telecommunications) , sputum , tuberculosis control , incidence (geometry) , epidemiology , demography , environmental health , pathology , physics , electrical engineering , optics , sociology , engineering
Summary Objective Geographical information systems are valuable tools for studying tuberculosis (TB) epidemiology, but have been underused for the evaluation of TB control programs. We aimed to compare the geographical distribution of TB before and after the five elements of directly observed therapy, short course (DOTS) were strengthened in a Health Jurisdiction in Mexico in response to recommendations made by the WHO Global Tuberculosis Program. Methods All consenting persons detected by passive case finding between March 1995 and February 2000 who were confirmed to have acid‐fast bacilli (AFB) in sputum underwent clinical and laboratory evaluation. A TB ‘episode’ was defined as the period of time between bacteriological diagnosis and treatment discharge by the local control programme. Distances of TB episodes from the nearest urban centre were determined according to recent transmission and multidrug resistance (MDR). Results During the first half of the study period, MDR episodes were located a median distance of 1.24 km from urban centres, which did not differ significantly from non‐MDR episodes (1.14 km, P = 0.56). In contrast, the median distance of MDR episodes increased 55% to 1.92 km during the second half, which placed them significantly further away out than non‐MDR episodes (1.08 km, P = 0.01). No changes in location were detected for recent transmission. Conclusion While reinforcing the TB control programme reduced the incidence of MDR, the remaining episodes were located in poorer and more remote areas.