RESUMO
CONTEXT: Stratification of social determinants leads to clustering of low socioeconomic communities, which then leads to spatio-temporal tuberculosis (TB) clusters. While previous studies have investigated spatio-temporal TB clusters, few have reported on the dynamics of them and the characteristics of social determinants. AIMS: To investigate the spatio-temporal dynamics of TB clusters in Bandar Lampung, Indonesia, from 2015 to 2016, and to identify the characteristics of population density and percentage of poverty of the clusters. SETTINGS AND DESIGN: A cross-sectional study was performed to analyze the spatio-temporal dynamics of TB clusters. The sample consisted of 705 TB patients (2015) and 1134 TB patients (2016), registered in 30 community health centers in Bandar Lampung, Indonesia. SUBJECTS AND METHODS: Geographical coordinates of the TB patients' residence were collected using Geographical Positioning System. Secondary data, consisting of population density and the percentage of poverty, were obtained from the subdistrict office in the region under investigation. STATISTICAL ANALYSIS: Data were analyzed with space-time permutation model using SaTScan software. RESULTS: Spatio-temporal dynamics of TB clusters were found in 2015 and 2016, including the number of significant clusters, TB cases within the clusters, as well as locations and sizes of the clusters. All the clusters were found to have similar social determinant characteristics: medium-high population density and low-medium percentage of poverty. CONCLUSIONS: TB control programs in countries with a high TB burden and low social determinants should consider the spatio-temporal dynamics of the TB cluster and its social determinant characteristics for a better TB's intervention.
RESUMO
CONTEXT: The current evidence shows that people in low-socioeconomic positions tend to be at high risk for tuberculosis (TB) transmission. AIMS: The aim of this study is to identify the significance of socioeconomic position and TB risk factors to TB transmission, particularly in Bandar Lampung, Indonesia. SETTINGS AND DESIGN: This cross-sectional study, conducting in January-November 2017, included 166 samples of smear-positive TB patients collected from 30 community health centers across the city that had implemented DOTS strategy. SUBJECTS AND METHODS: The latent variables consisted of the following: socioeconomic position, housing, nutritional, healthcare access, and TB transmission, which was measured through corresponding indicators. The data were collected through in-depth interviews. STATISTICAL ANALYSIS USED: Data analyzed using the partial least square method. RESULTS: Determinants of socioeconomic position through housing determinants significantly influence TB transmission with R 2 of 42.3%. They also show that education, housing density index, and internal house transmission are the strongest indicators in explaining their associated latent variables. CONCLUSIONS: TB control program should be integrated with education improvement, a reduction of housing density index, and strengthened examinations of internal house contacts. These programs should be supported by health institutions and other related institutions. The findings will improve TB control programs, especially in low- and middle-income countries with high-socioeconomic disparity.
