Characterization of geographic mobility among participants in facility- and community-based tuberculosis case finding in urban Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
International and internal migration are recognized risk factors for tuberculosis (TB). Geographic
mobility, including travel for work, education, or personal reasons, may also play a
role in TB transmission, but this relationship is poorly defined. We aimed to define geographic
mobility among participants in facility- and community-based TB case finding in
Kampala, Uganda, and to assess associations between mobility, access to care, and TB
disease.
Methods
We included consecutive individuals age �15 years diagnosed with TB disease through
either routine health facility practices or community-based case finding (consisting of doorto-
door testing, venue-based screening, and contact investigation). Each case was matched
with one (for community-based enrollment) or two (health facility enrollment) TB-negative
controls. We conducted a latent class analysis (LCA) of eight self-reported characteristics to
identify and define mobility; we selected the best-fit model using Bayesian Information Criterion.
We assessed associations between mobility and TB case status using multivariable
conditional logistic regression.
Results
We enrolled 267 cases and 432 controls. Cases were more likely than controls to have been
born in Kampala (p<0.001); there was no difference between cases and controls for remaining
mobility characteristics. We selected a two-class LCA model; the “mobile” class was perfectly
correlated with a single variable: travel (>3 km) from residence 2 times per month. Mobility was associated with a 28% reduction in odds of being a TB case (adjusted matched
odds ratio 0.72 [95% confidence interval 0.49, 1.06]).
Conclusion
Frequency of out-of-neighborhood travel is an easily measured variable that correlates
closely with predicted mobility class membership. Mobility was associated with decreased
risk of TB disease; this may be in part due to the higher socioeconomic status of mobile individuals
in this population. However, more research is needed to improve assessment of
mobility and understand how mobility affects disease risk and transmission.
Description
Keywords
Geographic mobility, Participants, Tuberculosis
Citation
Robsky KO, Isooba D, Nakasolya O, Mukiibi J, Nalutaaya A, Kitonsa PJ, et al. (2021) Characterization of geographic mobility among participants in facility- and community-based tuberculosis case finding in urban Uganda. PLoS ONE 16(5): e0251806. https://doi.org/10.1371/ journal.pone.0251806