Spatial and temporal distribution of drug-resistant tuberculosis and associated risk factors in the central region of Uganda (2019- 2023), a retrospective analysis

Abstract

<title>Abstract</title> <bold>Introduction</bold> Drug-resistant tuberculosis (DR-TB) poses a major public health threat in Uganda, especially in densely populated and urbanized Central Uganda. National estimates indicate that 1.6% of new cases and 12.1% of previously treated cases involve DR-TB, but specific data on its distribution and predictors in Central Uganda are limited. This study aimed to map the spatial and temporal distribution of DR-TB and identify associated risk factors from 2019 to 2023 to guide resource allocation. <bold>Methodology</bold> A cross-sectional retrospective study was conducted using data from DR-TB treatment centers in Central Uganda from January 2019 to December 2023. R (Version 4.4.0) statistical software and QGIS version 3.36.3 were used for spatial analysis, and significant clusters were identified using SaTscan’s Kulldorff statistic. Multivariable Poisson regression was employed to identify factors associated with DR-TB using STATA version 14. <bold>Results</bold> Of 803 DR-TB cases, 729 were eligible for analysis. The majority were male (69%), aged 25-34 (34.2%), married (51.9%), and HIV-positive (57.8%). Rifampicin resistance was found in 59% of cases. Kampala and Wakiso had the highest case numbers (30.0% and 24.3%, respectively), with fourteen hotspot clusters identified in these and other districts. Temporal analysis showed fluctuations, peaking in 2019 and 2022. Significant risk factors included age, sex, marital status, occupation, HIV status, and risk group. <bold>Conclusion</bold> DR-TB in Central Uganda clusters in urban districts, driven by urbanization, population density, and socioeconomic factors. Temporal fluctuations, influenced by disruptions like COVID-19, highlight the need for resilient healthcare systems. Key risk factors such as HIV co-infection, malnutrition, and demographics call for targeted interventions, integrated care, and enhanced surveillance.