Health seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda; Missed opportunity for early tuberculosis diagnosis

Winters Muttamba; Willy Ssengooba; Bruce Kirenga; Rogers Sekibira; Simon Walusimbi; Achilles Katamba; Moses Joloba

doi:10.1371/journal.pone.0217900

Health seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda; Missed opportunity for early tuberculosis diagnosis

PLoS One. 2019 Jun 6;14(6):e0217900. doi: 10.1371/journal.pone.0217900. eCollection 2019.

Authors

Winters Muttamba^{1

2}, Willy Ssengooba^{1

2}, Bruce Kirenga¹, Rogers Sekibira¹, Simon Walusimbi¹, Achilles Katamba³, Moses Joloba²

Affiliations

¹ Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
² Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda.
³ School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Chronic Disease
Cough / complications*
Female
Health Facilities
Humans
Male
Middle Aged
Patient Acceptance of Health Care*
Probability
Referral and Consultation*
Tuberculosis / diagnosis*
Tuberculosis / etiology*
Uganda / epidemiology
Young Adult

Grants and funding

This study was conducted with funding from the World Bank under the East African Public Health Laboratory Networking Project (EAPHLNP). he funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.