Missed opportunities in tuberculosis investigation and associated factors at public health facilities in Uganda

Abstract

Background The incidence of tuberculosis (TB) is high in Uganda; yet, TB case detection is low. The population-based survey on the prevalence of TB in Uganda revealed that only 16% of presumptive TB patients seeking care at health facilities were offered sputum microscopy or chest-X ray (CXR). This study aimed to determine the magnitude of, and patient factors associated with missed opportunities in TB investigation at public health facilities of Wakiso District in Uganda. Methods A facility-based cross-sectional survey was conducted at 10 high volume public health facilities offering comprehensive TB services in Wakiso, Uganda, among adults (≥18 years) with at least one symptom suggestive of TB predefined according to the World Health Organisation criteria. Using exit interviews, data on demographics, TB symptoms, and clinical data relevant to TB diagnosis were collected. A missed opportunity in TB investigation was defined as a patient with symptoms suggestive of TB who did not have sputum and/or CXR evaluation to rule out TB. Poisson regression analysis was performed to determine factors associated with missed opportunities in TB investigation. Results Two hundred forty-seven (247) patients with presumptive TB exiting at antiretroviral therapy (ART) clinics (n = 132) or general outpatient clinics (n = 115) at public health facilities were recruited into this study. Majority of participants were female (161/247, 65.2%) with a mean + SD age of 35.1 + 11.5 years. Overall, 138 (55.9%) patients with symptoms suggestive of TB disease did not have sputum and/or CXR examinations. Patients who did not inform health workers about their TB related symptoms were more likely to miss a TB investigation (adjusted prevalence ratio (aPR): 1.68, 95%CI; 1.36–2.08, P < 0.001). However, patients who reported duration of cough of 2 weeks or more were less likely to be missed for TB screening (aPR; 0.69, 95%CI; 0.56–0.86, p < 0.001). Conclusion There are substantial missed opportunities for TB diagnosis in Wakiso District. While it is important that patients should be empowered to report symptoms, health workers need to proactively implement the WHO TB symptom screen tool and complete the subsequent steps in the TB diagnostic cascade.

Missed Tuberculosis Investigations and Associated Factors in Patients with Symptoms Indicative of Tuberculosis at Public Health Institutions in Northwest Ethiopia: The Application of a Negative Binomial Model

“…Early identification and treatment of infectious TB cases is a primary strategy for TB control programs worldwide. 2 , 11 , 14 As a result, improving the performance of TB case detection (both active and passive) is critical for reducing TB transmission and burdens. 11 , 14 , 21 Taking this concept into consideration, this study attempted to assess the quality of facility-based TB case detection activity by estimating the number of patients who had suggestive of TB symptoms but were missed for TB diagnostic tests to rule out TB infection.…”

“… 2 , 11 , 14 As a result, improving the performance of TB case detection (both active and passive) is critical for reducing TB transmission and burdens. 11 , 14 , 21 Taking this concept into consideration, this study attempted to assess the quality of facility-based TB case detection activity by estimating the number of patients who had suggestive of TB symptoms but were missed for TB diagnostic tests to rule out TB infection. According to the findings of this study, 50 (12.14%) of patients with at least one TB symptom did not receive TB diagnostic services.…”

“… 11 , 12 However, the global and national TB case detection performances fall short of the expected TB case detection target. 1 , 13 , 14 Because of this and other factors, one-third of global estimated TB cases are missed. 11 , 12 This is possibly related to low TB case notification performance due to (poor accessibility and quality of TB services, limited health worker skills, patient delay and limited TB program budget), 2 , 6 , 11–13 and under-reporting of detected TB cases.…”

“… 11 , 12 This is possibly related to low TB case notification performance due to (poor accessibility and quality of TB services, limited health worker skills, patient delay and limited TB program budget), 2 , 6 , 11–13 and under-reporting of detected TB cases. 11 , 14 , 15 Missed TB cases result in having long infectious period, high TB disease complications, delayed treatment, death and high catastrophic costs for families. 11–16 As a result, improving the performance of low TB case notification becomes one of the primary gears of the End TB Strategy, which aims to eliminate TB burdens by 2030/5.…”

Perceptions of Adolescents and Health Workers Towards Adolescents’ TB Diagnosis in Central Uganda: A Cross-Sectional Qualitative Study

“…Moreover, people at public health facilities in Uganda are less likely to be evaluated for TB if they do not disclose TB symptoms to health workers. 23 Provision of adolescent friendly services while ensuring identification and minimisation of the barriers that prevent young people from opening up to health care workers has potential to improve TB care. In Uganda, the adolescent health policy guidelines and services standards exist.…”