Epidemiological analysis of tuberculosis in a remote district of Eritrea: implications for TB control strategies

Abstract Background: Tuberculosis (TB) is a major global health challenge, with an estimated 10 million new cases and 1.4 million deaths in 2019. However, despite the high burden of disease, TB remains a neglected and underfunded issue in many parts of the world. In this study, we aimed to provide information on the frequency and spatiotemporal distribution of TB in one of Eritrea's most remote areas, Nakfa, in order to better understand the local epidemiology of the disease. Methodology: We collected data from the Nakfa Hospital Registry on TB patients diagnosed between 2007 and 2021. We calculated the crude incidence rate (CIR) and the age-standardized rate (ASR) for the study population, and used a joint point regression model to analyze changes in incidence over time. Results: Of the 2,155 sputum samples collected in Nakfa during the study period, 165 (7.6%) were smear positive for pulmonary TB (PTB). An additional 104 patients were diagnosed with extrapulmonary TB, and 47 cases of PTB were diagnosed as smear-negative. Women accounted for a slightly larger proportion of TB cases than men, and the highest incidence rates were observed in individuals over the age of 45. Spatiotemporal analysis revealed that TB was concentrated in areas near the Nakfa Hospital. Conclusion: 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 in order to improve the detection and treatment of TB in Nakfa and other remote areas. Our study also highlights the need for continued investment in TB research and control efforts globally, in order to address this persistent public health challenge.