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

Abstract 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 <0.05) were found across the province in six sub‐districts: Mbombela, Nkomazi, Emalahleni, Govan Mbeki, Lekwa and Mkhondo. Mbombela has the highest number of significant clusters. The central region did not have any MDR‐TB clusters. Conclusion There is clear evidence of MDR‐TB clustering in Mpumalanga. This calls for concentrated TB prevention efforts and proper allocation of resources. Further investigations are needed to identify MDR‐TB predictors.