{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:59:56Z","timestamp":1792511996817,"version":"4.5.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>\n                    Tuberculosis (TB) remains a major public health challenge in Morocco. This study analyzed spatiotemporal patterns of TB cases in T\u00e9touan, Morocco using routine surveillance data from 2019\u20132023 (3,614 cases). Temporal trends and seasonality were assessed using seasonal\u2013trend decomposition, spatial dependence using Global Moran\u2019s I and Getis-Ord Gi*; and space\u2013time clustering using Kulldorff\u2019s scan statistic. The average annual TB incidence rate was 113 per 100,000 population. Men accounted for 62.94% (2,272\/3,614) of cases, with a mean age of 40.0 years (SD 19.1). Pulmonary TB (PTB) represented 56.71% (2,049\/3,614) of TB cases, of which 89.87% (1,828\/2,034) were bacteriologically confirmed. Notifications declined from 2019 to 2021, coinciding with COVID-19\u2013related service disruptions, followed by a resurgence in 2022\u20132023. Seasonal peaks were observed mainly in spring and autumn. Spatial analyses identified a persistent high-incidence hotspot in the urban municipality of T\u00e9touan. At the district level, space\u2013time analyses using Monte Carlo permutation tests implemented in SaTScan confirmed significant PTB clustering in urban slum districts, with relative risks (RR) ranging from 1.90 to 2.03 (p\u2009&lt;\u20090.01), suggesting stable reservoirs of TB transmission. Over time, clustering expanded beyond the urban core, with emerging TB hotspots in peri-urban communes (Azla, Zaitoune, and Beni Karrich). At the commune level, Azla and Zaitoune formed the most likely PTB cluster (RR 2.20 during 2022\u20132023;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), while a secondary high-risk cluster was detected in a rural commune (RR up to 3.00;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). These findings indicate that slums are entrenched reservoirs of transmission in urban settings, while peri-urban zones are emerging hotspots shaped by urbanization and mobility. Targeted strategies\u2014intensified case detection and social support in slums, mobile diagnostics in peri-urban and rural areas, and seasonally aligned control\u2014 combined with routine spatiotemporal surveillance may help reduce geographic inequities and strengthen TB control efforts.\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0006315","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:26:38Z","timestamp":1776705998000},"page":"e0006315","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Spatiotemporal patterns of tuberculosis in urban slums and urban\u2013rural transition zones: evidence from T\u00e9touan, Morocco, 2019\u20132023"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4718-0676","authenticated-orcid":true,"given":"Ayoub","family":"Ez-Zari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6508-3818","authenticated-orcid":true,"given":"Zaida","family":"Herrador","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7951-5415","authenticated-orcid":true,"given":"Laila","family":"Farouk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadya","family":"Mezzoug","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdnnor","family":"Boulaich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8778-7533","authenticated-orcid":true,"given":"Khalid","family":"Bouti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakaria","family":"Mennane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noureddine","family":"Elmtili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"pgph.0006315.ref001","volume-title":"Global 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