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Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems

Year: 2015
Type: article
Study design: Observational Study
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.
DOI: 10.4269/ajtmh.14-0754
Authors: Jennifer M. Ross, Adithya Cattamanchi, Cecily R. Miller, Andrew J. Tatem, Achilles Katamba, Priscilla Haguma, Margaret A. Handley, J. Lucian Davis
Institutions: San Francisco General Hospital, National Institutes of Health, University of California, San Francisco, University of Washington, Mulago Hospital, University of Southampton, Makerere University
Language: English
Field: Medicine
Open Access status: hybrid
Funders: U.S. Department of Homeland Security, Bill and Melinda Gates Foundation, Yale University, University of Washington, University of Southampton, National Institutes of Health, Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences, Yale University, University of California, San Francisco, Science and Technology Directorate, National Heart, Lung, and Blood Institute, National Institute of Allergy and Infectious Diseases, Fogarty International Center, School of Medicine, University of California, San Francisco
Awards: G3188278792, G3452734805, G4247444529, G49699897, G5312491478, Oral Wash for Nucleic Acid Diagnosis and Prognosis of TB in HIV-Infected Ugandans, G9000233776, G9000269343, STD and AIDS Research Training Grant, G97119092
OpenAlex ID: W2177533262
FWCI: 1.044
Cites: 33
Cited by: 20
Related to: 10