Spatial analysis on tuberculosis and the network of primary health care

ABSTRACT Objective: to analyze the spatial distribution of new cases of tuberculosis compared to the location of the Primary Healthcare Units that performed the compulsory notification. Method: ecological study conducted in Belém, Pará, with 5,294 new cases of tuberculosis notified to Sistema de Informação de Agravos de Notificação for the period from 2010 to 2014. The cases were georeferenced using the software applications ArcGis 10.2 and TerraView 4.2.2. The techniques of Kernel density and global Moran geostatistics were used. Results: the incidence of tuberculosis cases did not vary significantly between the years studied, however there was a variation in incidence between neighborhoods. Health units that exhibited higher number of notifications can suffer great influence of migration from nearby neighborhoods. Conclusion: the spatial dynamics of tuberculosis associated with health services allows to know the areas with increased risk of tuberculosis and the density of notifications of health units.摘要 研究目的：分析结核病新增病例的空间分布特征，并与开展强制报告工作的初级卫生保健机构（Primary Healthcare Units）的地理位置进行对比。 研究方法：本研究为在巴西帕拉州贝伦市开展的生态学研究，纳入2010至2014年期间上报至法定传染病报告信息系统（Sistema de Informação de Agravos de Notificação）的5294例结核病新增病例。研究采用ArcGIS 10.2与TerraView 4.2.2两款软件对病例进行地理编码，并运用核密度分析与全局莫兰地统计分析技术开展数据分析。 研究结果：研究时段内结核病病例的发病率无显著年际变化，但各街区间的发病率存在明显差异；报告病例数较多的卫生机构，其接收的病例或受周边街区人口迁移的显著影响。 研究结论：结合卫生服务开展的结核病空间动态分析，可明确结核病高风险区域以及各卫生机构的报告病例密度分布。