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Investigating barriers to tuberculosis evaluation in Uganda using geographic information systems

Investigating barriers to tuberculosis evaluation in Uganda using geographic information systems
Investigating barriers to tuberculosis evaluation in Uganda using geographic information systems
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
0002-9637
Ross, J.M.
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Cattamanchi, A.
4ec1bdfa-f18a-4409-84fe-5d0a9b0fb8a1
Miller, C.R.
e7606ae4-1f24-4432-9c13-aa93b8f364e0
Tatem, A.J.
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Katamba, A.
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Haguma, P.
db652072-9a96-4c2b-9931-12b372368dac
Handley, M.A.
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Davis, J.L.
64e20e3b-5d40-4ccf-adc1-cfc37e2e080f
Ross, J.M.
ac467ad4-06ca-4d6d-9674-0328d08947dc
Cattamanchi, A.
4ec1bdfa-f18a-4409-84fe-5d0a9b0fb8a1
Miller, C.R.
e7606ae4-1f24-4432-9c13-aa93b8f364e0
Tatem, A.J.
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Katamba, A.
0594cdcd-03a5-442a-8b2f-b2f7202c6ee9
Haguma, P.
db652072-9a96-4c2b-9931-12b372368dac
Handley, M.A.
65cbfb7a-48ad-4d39-bac7-97564df8271b
Davis, J.L.
64e20e3b-5d40-4ccf-adc1-cfc37e2e080f

Ross, J.M., Cattamanchi, A., Miller, C.R., Tatem, A.J., Katamba, A., Haguma, P., Handley, M.A. and Davis, J.L. (2015) Investigating barriers to tuberculosis evaluation in Uganda using geographic information systems. American Journal of Tropical Medicine and Hygiene. (doi:10.4269/ajtmh.14-0754).

Record type: Article

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

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More information

Accepted/In Press date: 23 May 2015
Published date: 2015
Organisations: Global Env Change & Earth Observation, WorldPop, Population, Health & Wellbeing (PHeW)

Identifiers

Local EPrints ID: 380089
URI: http://eprints.soton.ac.uk/id/eprint/380089
ISSN: 0002-9637
PURE UUID: bd90a6c8-c075-4898-969a-2f15c961dd6d
ORCID for A.J. Tatem: ORCID iD orcid.org/0000-0002-7270-941X

Catalogue record

Date deposited: 04 Sep 2015 09:05
Last modified: 15 Mar 2024 03:43

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Contributors

Author: J.M. Ross
Author: A. Cattamanchi
Author: C.R. Miller
Author: A.J. Tatem ORCID iD
Author: A. Katamba
Author: P. Haguma
Author: M.A. Handley
Author: J.L. Davis

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