ArticlePloS one2017
Spatial distribution of extensively drug-resistant tuberculosis (XDR TB) patients in KwaZulu-Natal, South Africa.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Spatial Distribution of COVID-19 Diagnostic Services in Mopani District, Limpopo Province, South Africa.Public health challenges · 2025Article
- Article
- Accessibility of TB diagnostic services at primary healthcare clinics in the eThekwini district, South Africa: a geospatial analysis.BMJ open · 2024Article
- Spatial heterogeneity of extensively drug resistant-tuberculosis in Western Cape Province, South Africa.Scientific reports · 2022Article
- Transmission, distribution and drug resistance-conferring mutations of extensively drug-resistant tuberculosis in the Western Cape Province, South Africa.Microbial genomics · 2022Article
- Article
- Diverse clinical and social circumstances: developing patient-centred care for DR-TB patients in South Africa.Public health action · 2021Article
- Decentralized Care for Rifampin-Resistant Tuberculosis, Western Cape, South Africa.Emerging infectious diseases · 2021Review
- Is distance associated with tuberculosis treatment outcomes? A retrospective cohort study in Kampala, Uganda.BMC infectious diseases · 2020Article
- Tuberculosis associated with the living conditions in an endemic municipality in the North of Brazil.Revista latino-americana de enfermagem · 2020Article
- Whole genome sequencing for drug-resistant tuberculosis management in South Africa: What gaps would this address and what are the challenges to implementation?Journal of clinical tuberculosis and other mycobacterial diseases · 2019Review
- Space-time clustering of recently-diagnosed tuberculosis and impact of ART scale-up: Evidence from an HIV hyper-endemic rural South African population.Scientific reports · 2019Article
- Transmission of drug-resistant tuberculosis in HIV-endemic settings.The Lancet. Infectious diseases · 2019Review
- Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa.The Journal of infectious diseases · 2018Article
- Article
- Geographic assessment of access to health care in patients with cardiovascular disease in South Africa.BMC health services research · 2018Article
- Geospatial mapping to identify feasible HIV prevention and treatment strategies that target specific settings.Annals of translational medicine · 2018Article
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Authors and funding
12 authors.
Funding
Abstract
backgroundKwaZulu-Natal province, South Africa, has among the highest burden of XDR TB worldwide with the majority of cases occurring due to transmission. Poor access to health facilities can be a barrier to timely diagnosis and treatment of TB, which can contribute to ongoing transmission. We sought to determine the geographic distribution of XDR TB patients and proximity to health facilities in KwaZulu-Natal.
methodsWe recruited adults and children with XDR TB diagnosed in KwaZulu-Natal. We calculated distance and time from participants' home to the closest hospital or clinic, as well as to the actual facility that diagnosed XDR TB, using tools within ArcGIS Network analyst. Speed of travel was assigned to road classes based on Department of Transport regulations. Results were compared to guidelines for the provision of social facilities in South Africa: 5km to a clinic and 30km to a hospital.
resultsDuring 2011-2014, 1027 new XDR TB cases were diagnosed throughout all 11 districts of KwaZulu-Natal, of whom 404 (39%) were enrolled and had geospatial data collected. Participants would have had to travel a mean distance of 2.9 km (CI 95%: 1.8-4.1) to the nearest clinic and 17.6 km (CI 95%: 11.4-23.8) to the nearest hospital. Actual distances that participants travelled to the health facility that diagnosed XDR TB ranged from <10 km (n = 143, 36%) to >50 km (n = 109, 27%), with a mean of 69 km. The majority (77%) of participants travelled farther than the recommended distance to a clinic (5 km) and 39% travelled farther than the recommended distance to a hospital (30 km). Nearly half (46%) of participants were diagnosed at a health facility in eThekwini district, of whom, 36% resided outside the Durban metropolitan area.
conclusionsXDR TB cases are widely distributed throughout KwaZulu-Natal province with a denser focus in eThekwini district. Patients travelled long distances to the health facility where they were diagnosed with XDR TB, suggesting a potential role for migration or transportation in the XDR TB epidemic.
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