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INTERNATIONAL JOURNAL OF GEOMATICS AND GEOSCIENCES

Volume 7, No 3, 2017

© Copyright 2010 All rights reserved Integrated Publishing services

Research article ISSN 0976 – 4380

Submitted on November 2016 published on February 2017 262

Tuberculosis types and its characteristics in Dindigul District – A

Geomedical study using GIS Vimala Vinnarasi J1 and Saravanabavan.V2

1- Research Scholar, Department of Geography, School of Earth and Atmospheric Sciences,

Madurai Kamaraj University, Madurai

1- Assistant Professor, Department of Geography, School of Earth and Atmospheric

Sciences, Madurai Kamaraj University, Madurai

[email protected]

Abstract

Disease means without illness or discomfort. The term disease broadly refers to any condition

that impairs normal function. Commonly this term is used to refer specially to infectious

disease. Tuberculosis (TB) is an infectious disease that has plagued humans. Since the

Neolithic times two organisms causes tuberculosis- Mycobacterium tuberculosis and

Mycobacterium bovis. Physicians in ancient Greece called this illness “phthisis” to reflect is

wasting character. Robert Koch isolated the tubercle bacillus in 1882 and established

tuberculosis as an infectious disease. Tuberculosis disease is classified into three categories-

pulmonary tuberculosis and extra pulmonary tuberculosis, Millary Tuberculosis. Pulmonary

tuberculosis has a chronic infection of the lungs. Extra pulmonary tuberculosis occurs

primarily in those with a compromised immune system. Millary Tuberculosis usually affects

erosion of the infection to a Pulmonary Vein.The symptoms of tuberculosis depend on where

in the body the tuberculosis bacteria are growing. Tuberculosis bacteria often grow in the

lungs, causing pulmonary tuberculosis. Pulmonary tuberculosis may cause a bad cough that

lasts longer than two weeks, pain in the chest and coughing up of blood or sputum. The main

objectives are, to analyses the spatial distribution of the tuberculosis types in Dindigul and

map out them. To study the disease pattern in relationship to case history and demographic

characteristic dimensions. The study will be analysed based on secondary data. Factor

analysis was used to identify the major dimensions of Tuberculosis treatments. GIS

techniques were used for mapping of Tuberculosis types and characteristics for the study.

Keywords: Mycobacterium tuberculosis, pulmonary tuberculosis, extra pulmonary

tuberculosis, tuberculosis treatment dimensions-factor analysis.

1. Introduction

Medical Geography (Health Geographic’s) is the branch of Human Geography that deals with

the geographic aspects of health (status) and healthcare (systems). Medical geography, a sub

discipline of geography, is an interdisciplinary and holistic study of health, illness, and

disease by specialists from a wide variety of social, physical, and biological sciences (May,

J.M. (1950). Medical Geography has been and continues to be can be gauged by books and

articles which continue to employ the theories and methods of disease and cultural ecology

and spatial analytic approaches. Learmonth (1978, 1987), Mayer (1986) and Meade et al.

(1988) were among the best known proponents of the use of disease and cultural ecology in

Medical Geography through the 1970s and 1980sWorking in different cultural systems and

diverse biospheres, medical geographers examine the distribution of health-related

Tuberculosis types and its characteristics in Dindigul District – A Geomedical study using GIS

Vimala Vinnarasi J and Saravanabavan.V

International Journal of Geomatics and Geosciences

Volume 7 Issue 3 2017 263

phenomena over time and the ways in which these phenomena interact and determine the

status of human health in a community. The importance of spatial analytic approaches in

Medical Geography continues. Major works exemplifying this tradition include Cliff and

Haggett (1988), Cliff et al. (2000), Gould, (1993), Joseph and Phillips (1984), Shannon and

Dever (1974) and Thomas (1992).

1.2. Tuberculosis

Tuberculosis is a leading killer of young adults worldwide and the global scourge of multi-

drug resistant tuberculosis is reaching epidemic proportions. It is endemic in most developing

countries and resurgent in developed and developing countries with high rates of human

immunodeficiency virus infection.

Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis

and is a major cause of morbidity and mortality, particularly in developing countries

Cegielski JP, Chin DP, Espinal MA, et al (2002), Corbett EL, Watt CJ, Walker N, et al.

(2003), Tufariello JM, Chan J, Flynn JL (2003). Mycobacterium is spread through the air and

usually infects the lungs, although other organs and parts of the body can be involved as well

(Andrew, Learmonth 1985). Robert Koch isolated the tubercle bacillus in 1882 and

established tuberculosis as an infectious disease

TB (short for tubercle bacillus) is a common, and in many cases lethal, infectious disease

caused by various strains of mycobacterium, usually Mycobacterium tuberculosis.

Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread

through the air when people who have an active MTB infection cough, sneeze, or otherwise

transmit their saliva through the air (Park. K 2009). Most infections in humans result in an

asymptomatic. Tuberculosis infection can lead to the potentially deadly tuberculosis (TB)

disease, which is most often treated with rigorous rounds of antibiotics. It can lead to serious

complications and even death, especially if the body is weakened by other health problems.

TB is passed on from person to person by droplets carried in the air, usually from coughs and

sneezes. Body's immune system, which fights infection, usually destroys the germs once they

are inhaled. In a small number of people, the immune system successfully builds a defensive

barrier around the infection. The bacteria stay in the body, but you won't usually have any

symptoms and can't pass the infection on to other people.

1.3. Types of tuberculosis

There are three types of tuberculosis, Pulmonary Tuberculosis, Extra pulmonary Tuberculosis

and Millary Tuberculosis.

1.3.1 Pulmonary tuberculosis

Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs, but

may spread to other organs. Pulmonary Tuberculosis and is a chronic infection of the lungs.

When the disease becomes active, 75% of the cases are pulmonary TB, that is, TB in the

lungs. Symptoms include chest pain, coughing up blood, and a productive, prolonged cough

for more than three weeks. Systemic symptoms include fever, chills, night sweats, appetite

loss, weight loss, pallor, and often a tendency to fatigue very easily. This occurs more

commonly in immunosuppressed persons and young children.

http://tuberculosis.emedtv.com/tuberculosis/tuberculosis.html

http://en.wikipedia.org/wiki/Bacillus_%28shape%29

http://en.wikipedia.org/wiki/Infectious_disease

http://en.wikipedia.org/wiki/Mycobacterium

http://en.wikipedia.org/wiki/Mycobacterium_tuberculosis

http://en.wikipedia.org/wiki/Lung

http://en.wikipedia.org/wiki/Asymptomatic

http://www.everydayhealth.com/tuberculosis/basics.aspx





1.3.2 Extra pulmonary tuberculosis

Extra pulmonary tuberculosis sites of infection commonly include lymph nodes, pleura, and

osterarticular areas. Extra pulmonary tuberculosis occurs primarily in those with a

compromised immune system. Extra pulmonary infection sites include the pleura in

tuberculosis pleurisy, the central nervous system in meningitis, and the lymphatic system in

scrofula of the neck, the genitourinary system in urogenital tuberculosis, and bones and joints

in Pott's disease of the spine. An especially serious form is disseminated TB, more commonly

known as Millary Tuberculosis. Extra Pulmonary TB may co-exist with pulmonary TB as

well. Extrapulmonary TB is rarely addressed in the public health literature. There are

however many clinical case reports and case series published, describing patients with

different forms of extrapulmonary TB Baveja CP et al (2010) Kriki P et al. (2009), Wiler JL

et al (2010).

1.4. Causes of tuberculosis

Tuberculosis is caused by infection with germs called Mycobacterium tuberculosis. These

bacteria were first identified in 1882 by Robert Koch who described their appearance under

the microscope as rod-shaped germs or bacilli. Tuberculosis can also afflict cattle, where the

infection is caused by a similar type of bacterium called Mycobacterium bovis.

Once inhaled, tubercle bacilli may reach the small breathing sacs in the lungs (the alveoli),

where they are taken up by cells called macrophages. The bacilli multiply within these cells

and then spread through the lymph vessels to nearby lymph nodes. Sometimes the bacilli

move through blood vessels to distant organs. At this point they may either remain alive but

inactive (quiescent), or they may cause active disease (Hyde, Walker and Margaret.O 1994).

Actual tissue damage is not caused directly by the tubercle bacillus, but by the reaction of the

person's tissues to its presence. In a matter of weeks the host develops an immune response to

the bacillus. Cells attack the bacilli, permit the initial damage to heal, and prevent future

disease permanently.

1.5. Transmission

TB is transmitted by droplet nuclei produced when infected persons cough or sneeze. After

inhalation, if a tubercle bacillus settles in an alveolus, infection occurs. Cell-mediated

immunity to the Mycobacteria, which develops about 3 to 6 weeks later, usually contains the

infection and arrests the disease.

1.6. Signs & symptoms

The primary stage of the tuberculosis may be symptom-free, or the individual may experience

a flu-like illness. TB mainly affects lungs and coughing is often the only indication of

infection initially. Symptoms of tuberculosis include cough (sometimes with haemoptysis or

blood in the sputum), chest pain, breathlessness, night sweats, and signs of pneumonia. In

advanced disease, there may be extreme weight loss. About a quarter of sufferers from the

disease die, most of them young adults (Dye 1999).

http://www.news-medical.net/health/What-is-the-Nervous-System.aspx

http://www.news-medical.net/health/What-is-Meningitis.aspx





2. Study area

Dindigul District is situated in the western part of Tamil Nadu. Dindigul District was carved

out of the composite Madurai District on 15.09.1985. It extends between 10º05 and 10º09

north latitude and 77º30 and 78º20 east longitude.

Figure 1: Location map of the study area

2.1. Aims and Objectives

1. To analyses the spatial distribution of the tuberculosis

2. To study the various types of life style and social aspects of the disease and to identify

the major dimensions and to explain each dimension and discuss the role of each one.

3. To study the tuberculosis disease pattern and demographic characteristics.

2.1.2. Methodology

The main source of study is the secondary data. It is collected from the government hospital

in Dindigul. The study area map particulars were collected from collectrate office. For the

preparation of maps GIS software and ERDAS image 8.5 and SPSS 7.5 Software packages

are used.

3. Distribution of tuberculosis in India

In India Tuberculosis evaluated more than 24 million people are evaluated with suspected TB,

examined more than 100 million sputum slides, treated more than 6 million patients, and

probably prevented more than a million TB deaths. In Tamilnadu there are 10 lakh people

infected with TB in Tamilnadu. This state about 1.4 lakh persons develop with tuberculosis,

among 48,000 have TB bacilli in their sputum.





Distribution of Tuberculosis in Dindigul District

DISTRIBUTION OF TUBERCULOSIS IN DINDIGUL DISTRICT

Dindigul

Athoor

Pappampatty

Eriodu

Perumalamalai

Figure 2: Distribution of Tuberculosis in Dindigul District

The distribution of Tuberculosis for the 2009 in (Fig No: 2) Dindigul district was divided into

392 villages as per 2001 census. The major Tuberculosis Unit division viz. Dindigul unit,

Athoor unit, Pappampatty unit, Eriodu unit, Perumalmalai unit, Dindigul District altogether

reported a total of 1199592 tuberculosis patients.

The incidence was generally found to be very highest in the Dindigul Unit. (397716) which

has the highest concentration of TB Secondly the TB unit of Athoor unit (313016) followed

by other Unit such as Eriodu (241925), Pappampatty (122028), Perumalmalai (124907).

Coolies, Mill workers, Tannery workers, Load man and others were the occupational groups

who were largely affected by TB. The age group of the affected belong to 30-45 years.

3.1 Distribution of pulmonary tuberculosis in Dindigul district

The distribution of pulmonary tuberculosis is that it is very high in male patients in Athoor

unit (389) and very low in Perumalmalai unit (42). The number of female patients are high in

the Pappampatty unit (139) and low in Perumalmalai unit (28).

3.2 Distribution of extra pulmonary tuberculosis in Dindigul district

The distribution of Extra pulmonary tuberculosis is that it is very high male patients in

Dindigul unit (138) and very low in Perumalmalai unit (13). Number of female patients are

high in the Dindigul unit (123) and the low level in Perumalmalai unit (23).





Figure 3: Total cases in Pulmonary Tuberculosis in Dindigul District

Figure 4: Total cases in Extra Pulmonary Tuberculosis in Dindigul District

4. Factor structure and factor solution

The four major dimensions of tuberculosis were analyzed with help of 54 variables drawn

from the secondary data. Many scholars already discussed the procedure and advantages of

the factor analysis Shanmuganandan .S (1994) incorported ‘‘Medical Geography, HIV Risk

behaviours knowledge and sero status of STD patients in Madurai city. Tamil Nadu, India,

and presented a paper in the Second International Congress on AIDS in Asia Pacific –New

Delhi”. Saravanabavan .V (1995, 1998, 2014) have elaborate The Geomedical analysis of

Leprosy: Epidemiological and Ecological Aspects of Tamil Nadu. The variables despict the

characteristics of tuberculosis in relation to their case history, treatment and characteristics,

mortality , detection rate, treatment failure variables. The first and the foremost factor

dimension Case History and Demographic Characteristics and Nature of Treatment with an





eigen value of 42.5 explained a total variance 52.1and from 2, 3 and 4 explained a total

variance of 72%, 86.9%, 88%.

The variable structure justified the selection of variable to reveal the characteristics of the

tuberculosis patient in the best possible manner. The factor analysis was used in the present

study to identify the major four determinants of the disease. The factor analysis resolved to

identify only the major dimensions but also the important variable that were associated with

each dimension.

Table 1: Percentage of variance

Table 2: Dimension – I: Case History and Demographic Characteristics and Nature of

Treatment

Variable

number Variable name Factor loading

3 Age group 15-24 male 0.77

4 Age group 15-24 female 0.77







13 Age group >65 male 0.85

15 New smear positive pulmonary Tb male 0.79

16 New smear positive pulmonary Tb female 0.90

18 New smear negative pulmonary Tb female 0.89

19 New Extra pulmonary Tb male 0.92

20 New Extra pulmonary Tb female 0.79

21 Relapses male 0.93

23 Failures male 0.87

25 Others female 0.86

26 Cured male 0.85

27 Cured female 0.91

28 Treatment completed male -0.76

29 Treatment completed female 0.94

30 Died male 0.91

32 Failure female 0.81

34 Defaulted male 0.69

S.No Name of the dimension Eigen

Value

Percentage

of Variance

Cumulative

Percentage

1

Case History and Demographic

Characteristics and Nature of

Treatment

42.5 49.1 52.1

2 Tuberculosis with Mortality Status 11.4 17 72

3 Roll of treatment and preventive

measure 8.1 11.9 86.9

4 The Importance of Treatment and

Detection Rate 5.4 10 88





38 Total new adult op 0.65

39 Sputum diagnosed 0.82

40 New smear positive cases 0.92

41 New smear negative cases 0.72

42 New Extra pulmonary tuberculosis 0.92

43 Total treated cases 0.85

48 Annualized sputum positive detection rate 0.81

50 Three month conversation rate -0.81

51 Sputum positive cases 0.92

52 Total New smear positive cases 0.81

53 Total Extra pulmonary Tuberculosis cases 0.79

54 Death cases 0.97

Eigen Value – 42.5 Percentage of Total Variance – 52.1

4.1 Dimension – I Case history and demographic characteristics and nature of

treatment

The primary factor highlights the case history and demographic. Characteristics and nature

of treatment. This factor contains as many as 34 variables with very high positive loading

and 2 variables with negative loading explaining as much as 52.1 percent of the total variance

with an eigen value 42.5 (Table 2). The highlight variable of age group is 35-45 male. 0.96

In this variable associated with the death cases. Very low factor in treatment completed (-

0.761). So this variable affected in the 35-45 male age group.

Figure 5: Case History and Demographic Characteristics and Nature of Treatment in

Dindigul District





Table 3: Dimension – II: Tuberculosis with mortality status

Variable Number Variable name Factor loading




14 >65 female 0.89

24 Treatment after default – male 0.79

34 Defaulted – male 0.67

36 Transfer to another district – male 0.71

38 Total new adult op 0.66

45 Success rate 0.62

46 Death rate -0.99

47 Default rate 0.78


4.2 Dimension – II Tuberculosis with mortality status

The second dimension is an important factor that highlights age group of <65 female. This

factor contains 13 variables (Table. 3) with the positive and negative loading explaining as

much as 19.9 percent of the total variance with an Eigen value 11.4. The very high positive

factor loading were seen in <64 female age group high in negative death rate -0.98. This

factor is named as TB with mortality status.

Figure: 6 Tuberculosis with Mortality Status in Dindigul District

Table 4: Dimension – III: Roll of treatment and preventive measure

Variable

number Variable name

Factor

loading


2 Age group 0-14 female -0.69


17 New smear negative pulmonary tuberculosis – male 0.79





22 Relapses – female 0.99

35 Defaulted – female 0.85

37 Transfer to another district – female 0.79

45 Success rate -0.78


4.3 Dimension – III Roll of treatment and preventive measure

The third dimension is knowledge on preventive measure and roll of treatment (Table 4).

This factor contains variables with the positive and negative loading explaining as much as

14.9 percentage of total variance with an Eigen value 8.1.

In 0.99 value indicates the very high positive loading were seen in relapses female variable

and the second negative loadings can be seen in 0-14 male age group in (-0.684), relapses

female is very high so the 0-14 male age group is very low level loading.

Figure : Roll of treatment and preventive measure in Dindigul District

Table 5: Dimension IV: The importance of treatment and detection rate

Variable number Variable name Factor loading

1 Age group 0-14 male -0.63



28 Treatment completed – male 0.61

31 Died - female 0.95

33 Failure – female 0.8

44 Cure rate 0.78

49 Detection rate 0.91

Eigen Value – 5 Percentage of Total Variance –13





4.4 Dimension IV the Importance of Treatment and Detection Rate

The fourth dimension is on the importance of treatment and detection rate. These factors

contains as many as 8 variables (Table 5) with positive a negative loading explaining as

much as 13 percentage of total variance with an eigen vale 5.4.

0-14 male, female age group is low rate of loading variable and then detection rate and failure

female variable is high on the female detection rate is high.

Figure 8: The Importance of Treatment and Detection Rate in Dindigul District

5. Conclusion

The studies done in Dindigul show a high TB prevalence incidence ratio among males based

on the age range analysed in the study. Tuberculosis is largely a preventable one and hence

scientific knowledge is essential to create a world in which an occurrence of a tuberculosis

disease can be prevented. Dindigul district was chosen and spatial distribution of

Tuberculosis in relation to the socioeconomic determinants, life style variation associated

with physical activities and living environmental conditions were analyzed The factor

analysis (multivariate analysis) was used in the present study to identify the major dimensions under the factor reduction process. According to factor solution, similarity and

factor loading matrix were used to derive the intercorrelation matrix, Eigen value and the

factor loading matrices.

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