{
  "abstract": "The COVID-19 pandemic substantially disrupted tuberculosis (TB) prevention, diagnosis, and treatment services worldwide. Despite increased TB notifications in Nepal during the post-pandemic recovery period, the geographic distribution and temporal clustering of notifications remain poorly understood. This study examined the spatial and temporal patterns of TB notifications across Nepal during the COVID-19 recovery period. We conducted a nationwide retrospective ecological analysis of district-level TB notifications across all 77 districts of Nepal from FY 2019/20 to FY 2023/24. Space-time, purely spatial, and purely temporal scan statistics were performed using a discrete Poisson model in SaTScan. Statistical significance was assessed using Monte Carlo simulation with 999 replications. A total of 172,155 TB cases were notified during the study period. TB notification rates increased by 51%, from 92 to 139 per 100,000 population between FY 2019/20 and FY 2023/24. Four statistically significant high-notification space-time clusters were identified (all p < 0.001). The primary cluster included Kathmandu, Lalitpur, Bhaktapur, Makwanpur, Bara, and Parsa districts during FY 2021/22-FY 2023/24 (RR = 1.60). Additional clusters were identified in western Nepal, the eastern Terai, and Rupandehi district. Purely temporal analysis showed a nationwide increase in notifications during FY 2022/23-FY 2023/24 (RR = 1.26, p = 0.001). TB notifications increased substantially during Nepals post-pandemic recovery period, with marked geographic and temporal heterogeneity. Integrating spatial and temporal surveillance may help identify areas requiring geographically targeted TB control strategies.",
  "abstract_shown": true,
  "affiliations": [
    "Pokhara University"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "N. Bisht"
    },
    {
      "name": "R. Bhatt"
    },
    {
      "name": "P. Rijal"
    },
    {
      "name": "R. K. Gupta"
    },
    {
      "affs": [
        0
      ],
      "name": "R. Bisht"
    },
    {
      "name": "H. Yadav"
    },
    {
      "name": "S. Singh"
    },
    {
      "name": "D. K. Kalwar"
    },
    {
      "name": "C. Adhikari"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/de31axtp8ng8q.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.25.26364053",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.25.26364053v1.full",
  "id": "de31axtp8ng8q",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.25.26364053v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "infectious diseases"
    ],
    [
      "openalex",
      "2725|Tuberculosis Research and Epidemiology"
    ]
  ],
  "openalex": "W7214769903",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.25.26364053v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-25",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/de31axtp8ng8q.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:37Z",
      "native_id": "10.64898/2026.09.25.26364053",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.25.26364053v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:infectious diseases",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Spatiotemporal clustering of tuberculosis notifications in Nepal during the COVID-19 pandemic and subsequent recovery: A national space-time scan analysis, 2019-2024",
  "title_text": "Spatiotemporal clustering of tuberculosis notifications in Nepal during the COVID-19 pandemic and subsequent recovery: A national space-time scan analysis, 2019-2024",
  "type": "preprint",
  "updated_at": "2026-10-30T12:19:37Z",
  "url": "https://research.draconitic.com/paper/de31axtp8ng8q",
  "venue": "medRxiv",
  "versions": []
}