Spatial distribution and clustering of multidrug-resistant tuberculosis in Uganda: a nationwide ecological study (2014-2023)

Background Multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) poses a major challenge to tuberculosis control, particularly in high-burden countries. While national surveillance data are routinely used to monitor MDR/RR-TB, reliance on national or regional aggregates may obscure important subnational heterogeneity. Evidence on the geographic distribution of MDR/RR-TB in Uganda remains limited. This study aimed to describe the national and subnational spatial distribution of MDR/RR-TB in Uganda over a ten-year period. Methods We conducted a national ecological geospatial analysis using routinely collected MDR/RR-TB surveillance data from Uganda’s District Health Information System 2 for the period 2014–2023. District- and regional-level notification data were mapped and analysed descriptively to characterise spatial patterns and changes over time. Results MDR/RR-TB notifications were highly heterogeneous across Uganda. The Central region consistently accounted for the highest burden, with persistent concentration in the Kampala metropolitan area. Selected districts in the Eastern and Northern regions showed increasing notifications in later years, while many districts reported persistently low or zero notifications throughout the study period. Conclusions MDR/RR-TB in Uganda is geographically patterned and dynamic over time. District-level geospatial analysis provides critical insights that are masked by regional summaries and can inform targeted MDR/RR-TB surveillance and control strategies.