OBJECTIVE: To describe the distribution of tuberculosis
(TB) and its drivers in Sheka Zone, a geographically
remote region of Ethiopia.
METHODS: We collected data on TB patients treated
from 2010 to 2014 in the Sheka Zone. Predictors of TB
incidence were determined using a multivariate generalised
linear regression model.
RESULTS: We found significant spatial autocorrelation
of TB incidence by kebele (the smallest administrative
geographical subdivision in Ethiopia) (Moran’s I¼0.3, P
, 0.001). The average TB incidence per kebele ranged
from 0 to 453 per 100 000 population per year, and was
significantly associated with average TB incidence
across adjacent kebeles, TB incidence in the same kebele
in the previous year and health facility availability. Each
increment in TB incidence by 10/100 000/year in
adjacent kebeles or in a previous year was associated
with an increase in TB incidence of respectively 3.0 and
5.5/100 000/year. Availability of a health centre was
associated with an increase in TB incidence of 84.3/
100 000.
CONCLUSIONS: TB incidence in rural Ethiopia is
highly heterogeneous, showing significant spatial autocorrelation.
Both local transmission and access to health
care are likely contributors to this pattern. Identification
of local hotspots may assist in developing and optimising
effective prevention and control strategies.