Mashamba, M.A.Tanser, F.Afagbedzi, S.Beke, Andy2022-09-052022-09-052022-02Mashamba, M.A., Tanser, F., Afagbedzi, S. & Beke, A. Multi-drug-resistant tuberculosis clusters in Mpumalanga province, South Africa, 2013–2016: A spatial analysis. Tropical Medicine and International Health 2022;27:185–191. https://doi.org/10.1111/tmi.13708.1360-2276 (print)1365-3156 (online)10.1111/tmi.13708https://repository.up.ac.za/handle/2263/87076OBJECTIVE : To identify spatial clusters with unusually high levels of MDR-TB, which are highly unlikely to have arisen by chance in Mpumalanga Province, South Africa. METHODS : Home addresses of all MDR-TB patients were collected from four MDR-TB facilities from 2013 to 2016. We mapped all addresses, linking them to the nearest ward with population estimates. A spatial analysis was conducted using kernel density in ArcGIS to estimate and map the distribution of the disease and used Gertis-Ord Gi to test for significant clustering. RESULTS : A total of 4065 MDR-TB patients were mapped. Ten significant clusters (p-value <0.05) were found across the province in six sub-districts: Mbombela, Nkomazi, Emalahleni, Govan Mbeki, Lekwa and Mkhondo. Mbombela has the highest number of significant clusters. The central region did not have any MDR-TB clusters. CONCLUSION : There is clear evidence of MDR-TB clustering in Mpumalanga. This calls for concentrated TB prevention efforts and proper allocation of resources. Further investigations are needed to identify MDR-TB predictors.en© 2021 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License.Multi-drug-resistant tuberculosis (MDR-TB)ClusteringGeographic information system (GIS)HotspotMpumalanga Province, South AfricaArticle