Multi-drug-resistant tuberculosis clusters in Mpumalanga province, South Africa, 2013–2016 : a spatial analysis

OBJECTIVE : To identify spatial clusters with unusually high levels of MDR-TB, which are highly unlikely to have arisen by chance in Mpumalanga Province, South Africa. METHODS : Home addresses of all MDR-TB patients were collected from four MDR-TB facilities from 2013 to 2016. We mapped all addresses, linking them to the nearest ward with population estimates. A spatial analysis was conducted using kernel density in ArcGIS to estimate and map the distribution of the disease and used Gertis-Ord Gi to test for significant clustering. RESULTS : A total of 4065 MDR-TB patients were mapped. Ten significant clusters (p-value