LATENT TUBERCULOSIS INFECTION PREVALENCE, SPATIAL CLUSTERING AND RISK FACTORS IN A SOUTH AFRICAN URBAN INFORMAL SETTLEMENT Public Deposited

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  • March 19, 2019
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  • Ncayiyana, Jabulani
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • This dissertation investigated the burden spatial clustering and risk factors of latent tuberculosis infection (LTBI), in a South African urban informal settlement. Using data from a large community-based household survey with random sampling and from the 2011 South African census as disseminated by Statistics South Africa (STATSSA), we estimated the prevalence of LTBI in the general population, the annual risk of infection (ARI) in children, and investigated individual-, household- and neighborhood-level factors associated with LTBI (paper 1). We assessed spatial heterogeneity of LTBI prevalence and the association between community-level factors and LTBI clusters (paper 2). In paper 1, we observed that the overall prevalence of LTBI was 34.3% (95% CI, 30% – 39%), the annual risk of infection among children age 0-14 years was 3.1% (95% CI: 2.1 - 5.2). In multivariable logistic regression analysis, LTBI was associated with age, male gender, marital status, and higher socio-economic status. In paper 2, we investigated the spatial clustering and spatial heterogeneity of LTBI prevalence and predictive community-level factors. One statistically significant cluster of high LTBI prevalence was found using the spatial scan statistic. Higher socio-economic status (SES) was associated with higher LTBI prevalence in both a non-spatial regression model and a geographically weighted regression (GWR) model. However, only a small part of the spatial heterogeneity in LTBI prevalence was explained by variation in community-level SES, suggesting that further research is needed to better understand the determinants of LTBI in such settings. Overall, this dissertation suggests that spatial analysis of LTBI can identify clusters within a single community and that LTBI prevalence is not associated with HIV status but may be associated with higher SES, in contrast to the well-established association between TB disease, HIV, and poverty.
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  • In Copyright
Advisor
  • Westreich, Daniel
  • van Rie, Annelies
  • Emch, Michael
  • Pettifor, Audrey
  • Musenge, Eustasius
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2015
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  • Chapel Hill, NC
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