Temporal And Spatial Distribution Characteristics And Influencing Factors Of Tuberculosis In Northeastern Yunnan Province

Tuberculosis(TB)is an infectious disease caused by the bacteria Mycoacterium tuberculosis.Pulmonary tuberculosis(PTB)is a result of an attack on the lungs by Mycobacterium tuberculosis.TB is prevalent all over the world from ancient time.The number of TB cases in China ranks third in the world.Therefore,the Chinese national authorities established the 12th five-year National TB Control Programme in 2011.The implementation of the integrated control strategies has helped control the burden of TB in China during the last five years.However,a continuous high PTB burden has been recorded in Zhaotong prefecture-level city,which is located in the northeastern part of Yunnan province.The notification rate of PTB in Zhaotong is higher than the rate reported for the province and for the Country.The results of domestic and international research showed that TB has special characteristics of space-time distribution,and it varies with social and environmental factors.It was important for effective prevention and control of the epidemic to understand the characteristics of spatial distribution and risk factors of TB,space-time scan statistic method was used to explore the spatial and temporal characteristics and to identify the spatial clustering area of PTB cases in Zhaotong City.Logistic regression model was used to analysis the risk factors affecting clustering,such as social economical status,personal behaviours,environmental and biological factors.Finally subject analysis was applied to analysis the factors that affect TB.So as to provide scientific evidence for adopting corresponding control measures and rational allocation of health resources.The main research methods and results are as follows:Part ? Spatial-temporal analysis of PTB in the northeast of the Yunnan provinceTime series and spatial cluster analyses were applied to detect PTB temporal trends and spatial patterns at the town level between 2011 and 2015 in Zhaotong.Our study shows there were spatial and temporal clusters that have been identified,other than a random pattern of the cases.Seasonal trends were detected with an apparent symptom onset peak during the winter season and a registration peak during the spring season.A most likely cluster and six secondary clusters were identified for the total PTB registration rate,one most likely cluster and five secondary clusters for the initial treatment registration rate,and one most likely cluster for the re-treatment registration rate.The most likely cluster of the three indicators had a similar spatial distribution and size in Zhenxiong County,which is characterised by a poor socio-economic level and the largest population in Yunnan.This areas should be given priority for TB control program.Part? The study of influencing factors of PTB spatial clusterThe research objects are registered PTB cases in Zhaotong City from October 2015 to February 2016.Logistic regression was used to compared the social economical status,personal behaviours,environmental and biological characteristics of PTB cases in spatial clusters versus PTB cases not in spatial clusters.Logistic regression analysis showed that history of chronic bronchitis,living in the urban area,smoking and using coal as the main fuel were the risk factors of clustering.Interventions to prevent the clustering should be focused on these associated factors.Part? To assess the contribution of health seeking behaviour to the distribution of PTB1508 patients registered in Zhaotong city between October 2015 and February 2016 were investigated by questionnaire.Information about their knowledge of tuberculosis and their behavior of seeking medical advice were collected.Data were compared between clustered and not clustered cases.Our study shows that the total correct answer rate for tuberculosis knowledge was 70.56%,more was known about TB symptoms than about the free treatment.There were significant differences about confirmed delay,health facility selection for first health care seeking,initial diagnosis,visiting times,therapeutic category,management method,supervisor between clustered and not clustered cases.The differences in tuberculosis-related health seeking behavior between cases in cluster and not in cluster may play an important role in facilitating or impeding the spread of the disease in this region.