# Spatiotemporal hotspot analysis of tuberculosis lost to follow-up cases in Ghana: A district-level study from 2019–2023

## TL;DR

This study uses spatiotemporal analysis to identify hotspots of tuberculosis cases lost to follow-up in Ghana from 2019 to 2023, aiming to improve treatment success rates.

## Contribution

The study introduces spatiotemporal hotspot analysis as an underutilized method to address TB lost to follow-up in Ghana.

## Key findings

- TB lost to follow-up cases showed significant spatial clustering in Eastern, Central, and Greater Accra regions.
- Hotspot areas were primarily found in densely populated districts, especially in Greater Accra, Central, and Eastern regions.
- The spatial clustering of LTFU cases decreased over time, becoming more random in 2022 and 2023.

## Abstract

Despite existing measures to control Tuberculosis (TB), the burden of TB remains a serious challenge in Ghana, with declining treatment success rates over recent years. Lost to Follow-Up (LTFU) has been attributed to this decline. This cross-sectional study aims to employed spatiotemporal analysis, an underutilized approach in this context, to explore areas with high prevalence of LTFUs in order to improve TB treatment success rates.

A spatiotemporal analysis was conducted in Ghana using TB LTFU data from 2019–2023 extracted from the District Health Information Management System 2 (DHIMS2). Proportions of LTFU were used for spatial mapping. We adopted the Global Moran’s I, LISA and Getis-Ord G* techniques to determine spatial autocorrelation, optimized clusters or outliers and identify hotspot areas respectively.

A total of 2,887 TB LTFU cases were recorded out of 75,604 TB cases. We observed an initial increase of TB LTFU from 2019 (4.12%) to 2020, and a diminishing trend (5.28% to 3.11%) from 2020 to 2023. The Global Moran’s I estimations showed significant spatial clustering of TB LTFU cases from 2019 to 2021, shifting to a more random distribution in 2022 and 2023. High spatial clustering of LTFU were primarily reported in districts within Eastern, Central, and Greater Accra regions across 2019–2023, with clusters in Volta and Ashanti regions in 2021. We identified significant hotspot areas in districts within Greater Accra, Central, and Eastern regions.

Hotspot areas of TB LTFU were primarily identified in densely populated regions. Strategic plans such as intensive education programs should be implemented to address pertinent issues regarding LTFU in the affected districts. Priorities should be directed towards populated regions, particularly Greater Accra, Central and Eastern regions, to improve TB treatment adherence and outcomes.