Date of Award

January 2020

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Luke Davis

Abstract

Infectious diseases like tuberculosis are undergoing an epidemiological transformation in developing countries such as Colombia and throughout Latin America. Recent economic and social developments may drive heterogeneous burdens of disease in the region, especially in urban settings. Geographic Information Systems (GIS) may allow us to better appreciate the geospatial distributions of TB in these contexts. In this study, we aimed to identify regions in Santiago de Cali facing disproportionate TB burdens and sought to determine whether the distribution of drug resistant TB differed. Additionally, we aimed to identify patient risk factors that could lead to differential drug resistance testing. This secondary data analysis utilized GIS to identify hotspots of TB transmission within the city of Santiago de Cali from 2013-2018. Poisson regression models, bivariate, and multivariable analyses were employed to identify patient characteristics strongly associated with TB rates and resistance testing at the barrio and comuna levels. Our results revealed a heterogeneous distribution of disease associated with ecological socioeconomic indicators, and identified nearly identical clustering of disease between resistant and drug susceptible tuberculosis (DR and DS-TB). Our models highlighted patient characteristics positively associated with resistance testing such as drug use, homelessness, and previous treatment history. Overall, these findings highlight the value of geospatial analyses of infectious diseases whereby we identify urban TB hotspots and reveal factors associated with resistance testing. These observations pave the way for better targeted and more equitable public health interventions seeking to reduce TB burden in Cali or other urban settings.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/27/2022

Share

COinS