# Spatio-temporal distribution of COVID-19 cases and tuberculosis in four provinces of Sumatra Islands, Indonesia

## TL;DR

This study examines how the COVID-19 pandemic affected tuberculosis case reporting in four provinces of Sumatra, Indonesia.

## Contribution

The study identifies an immediate negative association between high COVID-19 case numbers and tuberculosis notifications.

## Key findings

- Time series cluster analysis revealed five clusters for both tuberculosis and COVID-19 case notifications.
- A negative association was found between more than 10,000 reported COVID-19 cases and tuberculosis notifications with a 0-month lag (RR = 0.95).
- The findings suggest disruption of Indonesia’s tuberculosis program during the pandemic in the studied provinces.

## Abstract

The COVID-19 pandemic disrupted national tuberculosis programs in high-burden countries. We hypothesize that COVID-19 occurrence had a delayed effect on tuberculosis case reports from the Indonesia Ministry of Health, also known as the tuberculosis case notification. The objectives of this study are: (1) to describe the potential effect of the reported COVID-19 cases on the spatial distribution of tuberculosis in four provinces of Sumatra Islands (Aceh, North Sumatra, West Sumatra, and Riau Provinces), Indonesia; (2) to estimate the temporal lag effect of the occurrence of COVID-19 on tuberculosis case notifications.

We retrieved data from the Indonesian Ministry of Health and the Indonesia COVID-19 Task Force. We also examined the monthly tuberculosis and COVID-19 case notifications. We identified time series clusters of tuberculosis case notifications and used lag non-linear model to assess the delayed effect of the occurrence of COVID-19 cases on tuberculosis case notifications.

The secondary data included 217,593 tuberculosis case notifications (January 2019 to December 2022) and 373,671 reported COVID-19 cases (January 2020 to December 2022). Time series cluster analysis revealed 5 clusters each for monthly tuberculosis case notifications and monthly reported COVID-19 cases. There was a negative association with a 0-month lag in more than 10,000 reported COVID-19 cases (RR = 0.95, 95%CI: 0.91–0.98).

The findings suggested that Indonesia’s national tuberculosis program in four provinces of Sumatra Island was disrupted during the COVID-19 pandemic. Lag analysis showed that COVID-19 case occurrence had an immediate effect on tuberculosis case notifications.

Not applicable.

The online version contains supplementary material available at 10.1186/s12889-025-21754-z.