Health seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda; Missed opportunity for early tuberculosis diagnosis
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Tuberculosis (TB) is the 9th leading cause of death from a single infectious agent. Patients
live in a complex health care system with both formal and informal providers, and it is important
that a TB diagnosis is not missed at the first interaction with the health care system. In
this study, we highlight the health seeking behavior of patients and missed opportunities for
early TB diagnosis for which interventions could be instituted to ensure early TB diagnosis
and prompt TB treatment initiation.
Methods
This study was nested in a cross-sectional study that assessed the accuracy of different
Xpert MTB/Rif implementation strategies in programmatic settings at the referral hospitals
in Uganda. We documented the symptom profile of presumptive TB patients and assessed
the health seeking behavior of those with chronic cough by calculating proportion of patients
that visited each type of health facility and further calculated the odds of being TB positive
given the type of health facility initially visited for consultation.
Results
A total of 1,863 presumptive TB patients were enrolled of which 979 (54.5%) were male, and
1795 (99.9%) had chronic cough. A total of 1352 (75.4%) had previously sought care for
chronic cough, with 805 (59.6%) seeking care from a public health facility followed by private
health facility (289; 21.4%). Up to 182 (13.5%) patients visited a drug store for chronic
cough. Patients whose first contact was a private health facility were more likely to have a
positive GeneXpert test (adjOR 1.4, 95% CI: 1.0–1.9; p = 0.047). Conclusions
Chronic cough is a main symptom for many of the presumptive TB patients presenting at
referral hospitals, with several patients having to visit the health system more than once
before a TB diagnosis is made. This suggests the need for patients to be thoroughly evaluated
at first interface with the health care system to ensure prompt diagnosis and treatment
initiation. Improved TB diagnosis possibly with the GeneXpert test, at first contact with the
health care system has potential to increase TB case finding and break the transmission
cycle in the community.
Description
Keywords
Health seeking behavior, Individuals, Chronic cough, Referral hospitals
Citation
Muttamba W, Ssengooba W, Kirenga B, Sekibira R, Walusimbi S, Katamba A, et al. (2019) Health seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda; Missed opportunity for early tuberculosis diagnosis. PLoS ONE 14(6): e0217900. https://doi.org/10.1371/journal. pone.0217900