Spatial and Temporal Variations in Newly Notified Pulmonary Tuberculosis Cases in the Volta Region, Ghana (2019–2023)

Abstract

Background: Tuberculosis (TB) is a major global health challenge and remains a leading infectious cause of morbidity and mortality worldwide. It disproportionately affects low- and middle-income countries, where socioeconomic disparities, limited access to healthcare, and environmental factors contribute to its burden. In Ghana, the Volta Region has experienced variability in TB prevalence, driven by factors such as poverty, urbanisation, and healthcare inequities. However, evidence on the spatial and temporal patterns of drug-susceptible TB cases in the region remains limited. Understanding these variations is essential for designing effective interventions, prioritising resource allocation, and achieving the goals of the World Health Organization’s (WHO) End TB Strategy. Aim: This study aimed to investigate spatial and temporal variations in drug-susceptible TB cases in the Volta Region, Ghana, from 2019 to 2023. Methods: A retrospective study design was employed using secondary data from the District Health Information Management System 2 (DHIMS2). Temporal trends were analysed using a line graph, while spatial patterns were examined using QGIS. Measures of spatial autocorrelation, including Global Moran’s I and Local Indicators of Spatial Association (LISA), were used to identify districts with high or low TB prevalence. Results: The analysis revealed fluctuating TB prevalence in the Volta Region from 2019 to 2023. TB prevalence decreased from 50.2 per 100,000 population in 2019 to 43.6 in 2020, followed by a steady increase to 62.1 per 100,000 in 2023. Males consistently exhibited a higher TB prevalence than females, with an overall male-to-female ratio of 1.92. By 2023, TB prevalence was 84.9 per 100,000 among males and 40.5 per 100,000 among females. Spatial analysis identified Keta and Kpando as high-prevalence districts for drug-susceptible TB. Emerging hotspots included Hohoe, Akatsi South, and Ketu North, which experienced increasing prevalence over time. Cold spots with consistently low TB prevalence were observed in districts such as Adaklu, Agortime-Ziope, and Ho West. High-prevalence districts demonstrated concentrated clustering, whereas overall spatial autocorrelation was random across the region. Conclusion: The study identified an increasing trend in TB prevalence over the five-year period, with males consistently exhibiting higher rates than females. High-prevalence districts, such as Keta and Kpando, and emerging hotspots, including Akatsi South and Ketu North, highlight areas requiring targeted interventions. Low-prevalence districts, including Adaklu, Agortime-Ziope, and Ho West, may provide insights into effective TB-control strategies. Tailored public health measures are essential to address the identified spatial and temporal disparities in TB prevalence.