title: Changes in the geographical distribution of tuberculosis patients in Veracruz, Mexico, after reinforcement of a tuberculosis control programme.
abstract: OBJECTIVE
  Geographical information systems are valuable tools for studying tuberculosis (TB) epidemiology, but have been underused for the evaluation of TB control programs. We aimed to compare the geographical distribution of TB before and after the five elements of directly observed therapy, short course (DOTS) were strengthened in a Health Jurisdiction in Mexico in response to recommendations made by the WHO Global Tuberculosis Program.
  
  
  METHODS
  All consenting persons detected by passive case finding between March 1995 and February 2000 who were confirmed to have acid-fast bacilli (AFB) in sputum underwent clinical and laboratory evaluation. A TB 'episode' was defined as the period of time between bacteriological diagnosis and treatment discharge by the local control programme. Distances of TB episodes from the nearest urban centre were determined according to recent transmission and multidrug resistance (MDR).
  
  
  RESULTS
  During the first half of the study period, MDR episodes were located a median distance of 1.24 km from urban centres, which did not differ significantly from non-MDR episodes (1.14 km, P=0.56). In contrast, the median distance of MDR episodes increased 55% to 1.92 km during the second half, which placed them significantly further away out than non-MDR episodes (1.08 km, P=0.01). No changes in location were detected for recent transmission.
  
  
  CONCLUSIONS
  While reinforcing the TB control programme reduced the incidence of MDR, the remaining episodes were located in poorer and more remote areas.
authors.affiliation: Stanford University, Palo Alto, CA, USA. lmj@stanford.edu
authors.forename: Lara M
authors.initials: LM
authors.lastname: Jacobson
authors.forename: Ma
authors.initials: M
authors.lastname: de Lourdes Garcia-Garcia
authors.forename: Juan Eugenio
authors.initials: JE
authors.lastname: Hernandez-Avila
authors.forename: Bulmaro
authors.initials: B
authors.lastname: Cano-Arellano
authors.forename: Peter M
authors.initials: PM
authors.lastname: Small
authors.forename: Jose
authors.initials: J
authors.lastname: Sifuentes-Osornio
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ponce-de-Leon
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006078:Government Programs; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D015397:Program Evaluation; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology; D014504:Urban Health
chemical_list: D000995:Antitubercular Agents