Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems
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Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
The American journal of tropical medicine and hygiene
Abstract
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.
Description
Keywords
Barriers, Tuberculosis Evaluation, Geographic Information Systems
Citation
Ross, J. M., Cattamanchi, A., Miller, C. R., Tatem, A. J., Katamba, A., Haguma, P., ... & Davis, J. L. (2015). Investigating barriers to tuberculosis evaluation in Uganda using geographic information systems. The American journal of tropical medicine and hygiene, 93(4), 733. doi:10.4269/ajtmh.14-0754