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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
06/06/2019
Author
Muttamba, Winters
Ssengooba, Willy
Kirenga, Bruce
Sekibira, Rogers
Walusimbi, Simon
Katamba, Achilles
Joloba, Moses
Keywords
Adolescent
Adult
Chronic disease
Cough/complications
Female
Health facilities
Humans
Male
Middle aged
Patient acceptance of health care
Probability
Referral and consultation
Tuberculosis/diagnosis
Uganda/epidemiology
Young adult
RA0421 Public health. Hygiene. Preventive Medicine
DAS
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Abstract
Background: 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.
Citation
Muttamba , W , Ssengooba , W , Kirenga , B , Sekibira , R , Walusimbi , S , Katamba , A & Joloba , M 2019 , ' Health seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda; missed opportunity for early tuberculosis diagnosis ' , PLoS ONE , vol. 14 , no. 6 , e0217900 . https://doi.org/10.1371/journal.pone.0217900
Publication
PLoS ONE
Status
Peer reviewed
DOI
https://doi.org/10.1371/journal.pone.0217900
ISSN
1932-6203
Type
Journal article
Rights
Copyright: © 2019 Muttamba et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Description
Funding: This study was conducted with funding from the World Bank under the East African Public Health Laboratory Networking Project (EAPHLNP).
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  • University of St Andrews Research
URI
http://hdl.handle.net/10023/21679

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