Date of Award

Spring 5-2019

Degree Name

Master of Public Health (MPH)

Advisor(s)

JOESPH B. MCCORMICK, MD

Second Advisor

KRISTY O. MURRAY, DVM, PHD

Third Advisor

LU-YU HWANG, MD

Abstract

Worldwide, children represent approximately 10% of global tuberculosis (TB) cases. We recently reported a high tuberculin skin test (TST)-positive prevalence (355/5,476; weighted prevalence=6.4%) among children (<15 years) throughout the island of Bohol, Philippines, with some geographically isolated communities having prevalence as high as 29%. In this study, we conducted a secondary geospatial and hot-spot analysis of this household-based cluster survey to assess the association between access to care (distance to a health care facility) and TST-positive prevalence. Our analysis indicated that villages with high TST-positive prevalence (≥10%) were significantly further from Provincial Health Office based in the capital city of Tagbilaran in time-distance (p=0.0001, r=0.2387) and kilometers (p=0.0011, r=0.3170). Similarly, prevalence was positively correlated with distance to the municipal Rural Health Unit (RHU), where most receive their medical care, in time-distance (p=0.0055; r=0.0415); however, the association was not significant in kilometers (p=0.3315; r=0.0715). Distance to health care facilities could represent an obstacle to access to care, thereby limiting diagnosis and treatment and resulting in increased risk of transmission to others in the community. Health care outreach in geographically isolated areas is critical to treatment and control of efforts for pediatric TB.

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