title: Pattern and spatial distribution of plague in Lushoto, north-eastern Tanzania.
abstract: A review of plague records from 1986 to 2002 and household interviews were carried out in the plague endemic villages to establish a pattern and spatial distribution of the disease in Lushoto district, Tanzania. Spatial data of households and village centres were collected and mapped using a hand held Global Positioning System and Geographical Information System. During the 16-year period, there were 6249 cases of plague of which 5302 (84.8%) were bubonic, 391 (6.3%) septicaemic, and 438 (7.0%) pneumonic forms. A total of 118 (1.9%) cases were not categorized. Females and individuals aged 7-18 years old were the most affected groups accounting for 54.4% (95% CI: 52.4-56.0) and 47.0% (95% CI: 45-49) of all reported cases, respectively. Most cases were found in villages at high altitudes (1700-1900m); and there was a decline in case fatality rate (CFR) in areas that experienced frequent outbreaks. Overall, there was a reduction in mean reporting time (from symptoms onset to admission) to an average of 1.35 days (95% CI: 1.30-1.40) over the years, although this remained high among adult patients (>18 years). Despite the decrease in the number of cases and CFR over the years, our findings indicate that Lushoto district experiences human plague epidemic every year; with areas at high altitudes being more prone to outbreaks. The continued presence of plague in this focus warrants further studies. Nonetheless, our findings provide a platform for development of an epidemic preparedness plan to contain future outbreaks.
authors.affiliation: National Institute for Medical Research, Tanga Medical Research Centre, P.O. Box 5004, Tanga, Tanzania. mkamugisha@amani.mimcom.com
authors.forename: M L
authors.initials: ML
authors.lastname: Kamugisha
authors.forename: S
authors.initials: S
authors.lastname: Gesase
authors.forename: D
authors.initials: D
authors.lastname: Minja
authors.forename: S
authors.initials: S
authors.lastname: Mgema
authors.forename: T D
authors.initials: TD
authors.lastname: Mlwilo
authors.forename: B K
authors.initials: BK
authors.lastname: Mayala
authors.forename: S
authors.initials: S
authors.lastname: Msingwa
authors.forename: J J
authors.initials: JJ
authors.lastname: Massaga
authors.forename: M M
authors.initials: MM
authors.lastname: Lemnge
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000531:Altitude; D002648:Child; D002675:Child, Preschool; D003710:Demography; D018563:Disease Notification; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D040362:Geographic Information Systems; D005843:Geography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010930:Plague / Q000145:classification / Q000453:epidemiology* / Q000401:mortality; D012042:Registries; D012423:Rural Health / Q000706:statistics & numerical data; D017678:Sex Distribution; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors