Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems

Reducing geographic barriers to tuberculosis (TB) care is a priority in high-burden countries where patients frequently initiate, but do not complete, the multi-day TB evaluation process. Using routine cross-sectional study from six primary-health clinics in rural Uganda from 2009 to 2012, we explor...

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Published inThe American journal of tropical medicine and hygiene Vol. 93; no. 4; pp. 733 - 738
Main Authors Ross, Jennifer M, Cattamanchi, Adithya, Miller, Cecily R, Tatem, Andrew J, Katamba, Achilles, Haguma, Priscilla, Handley, Margaret A, Davis, J Lucian
Format Journal Article
LanguageEnglish
Published United States The American Society of Tropical Medicine and Hygiene 01.10.2015
Subjects
Adolescent
Adult
Age Factors
Cross-Sectional Studies
Female
Geographic Information Systems
Health Services Accessibility - statistics & numerical data
Humans
Male
Middle Aged
Mycobacterium
Sex Factors
Sputum - microbiology
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - epidemiology
Uganda - epidemiology
Young Adult
Uganda
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Summary:Reducing geographic barriers to tuberculosis (TB) care is a priority in high-burden countries where patients frequently initiate, but do not complete, the multi-day TB evaluation process. Using routine cross-sectional study from six primary-health clinics in rural Uganda from 2009 to 2012, we explored whether geographic barriers affect completion of TB evaluation among adults with unexplained chronic cough. We measured distance from home parish to health center and calculated individual travel time using a geographic information systems technique incorporating roads, land cover, and slope, and measured its association with completion of TB evaluation. In 264,511 patient encounters, 4,640 adults (1.8%) had sputum smear microscopy ordered; 2,783 (60%) completed TB evaluation. Median travel time was 68 minutes for patients with TB examination ordered compared with 60 minutes without (P < 0.010). Travel time differed between those who did and did not complete TB evaluation at only one of six clinics, whereas distance to care did not differ at any of them. Neither distance nor travel time predicted completion of TB evaluation in rural Uganda, although limited detail in road and village maps restricted full implementation of these mapping techniques. Better data are needed on geographic barriers to access clinics offering TB services to improve TB diagnosis.
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ISSN:0002-9637
1476-1645
DOI:10.4269/ajtmh.14-0754