Epidemiological Analysis of Tuberculosis in Nakfa District, Eritrea: A 14 Year Spatiotemporal Study and Implications...

Tuberculosis (TB) remains a major global health challenge, with an estimated 10 million new cases and 1.4 million deaths in 2019. Despite this high burden, TB management, control, and overall funding continue to be suboptimal in many parts of the world. In this study, we aimed to provide information on the frequency and spatiotemporal distribution of TB in Nakfa, one of the most remote regions of Eritrea.

We analyzed 2,155 TB cases recorded from 2007 to 2021. Data were collected from paper-based hospital and registry records at Nakfa Hospital. Demographic information was analyzed using relevant descriptive statistics, including mean ± SD and frequencies. Additional analyses included crude and adjusted incidence rates, annual percentage change (APC), and spatiotemporal distribution of cases. All analyses were conducted using SPSS version 26 for Windows (SPSS Inc. Chicago, Illinois, USA), Joinpoint Regression Program version 4.9.0, and ArcGIS (ArcMap v 10.7.1; Esri, Redlands, CA, USA).

A total of 2,155 suspected TB cases were reported during the study period. Of these, 1,839 (85.3%) were negative, 165 (7.7%) were smear-negative, 47 (2.2%) were smear-positive, and 104 (4.8%) were extrapulmonary TB cases. The mean age ± SD was 35.18 ± 17.74 years. Regarding sex, the female-to-male distribution was 1,213 (56.3%) and 942 (43.7%), respectively. The average annual incidence rate of TB during the study period (2007-2021) was 55.64 cases per 100,000 inhabitants. Over this period, the crude and age-adjusted incidence rates (aAR) increased from 2009 (aAR = 57.96) to 2018 (aAR = 91.67). In terms of sex, the incidence of TB was disproportionately higher in females (124.87 per 100,000 vs. 65.13 per 100,000 in males in 2017). Spatiotemporal analysis revealed that TB was concentrated in areas near Nakfa Hospital.

Our findings suggest that TB incidence in Nakfa district is relatively stable, but the distribution of the disease is uneven and may be associated with a lack of TB care services in some subzones. We recommend greater decentralization of TB care services and increased case-finding activities to improve the detection and treatment of TB in Nakfa and other remote areas.