Delay in Diagnosis of Tuberculosis Among Patients Attending Kampala Capital City Authority TB Diagnostic and Treatment Units in Uganda.

Abstract

Introduction Kampala Capital City Authority (KCCA) TB diagnostic and treatment units are the main publichealth units offering free TB diagnostic services in Kampala City, so identifying factorscontributing to the delay to diagnose TB would be a step forward in reducing TB transmission,morbidity and mortality.

Delay in diagnosis of tuberculosis (TB) results in severe disease and higher mortality. It also increases the duration of infectivity in the population (WHO, 2013). Early detection and diagnosis of TB cases is the hallmark of all successful TB control programs.

Objective of the study The main objective of the study was to determine the factors contributing to the delay to diagnose TB among patients attending KCCA TB diagnostic and treatment units in the period of July to August 2014. The specific objectives were to determine the socio-demographic, patient and health facility factors contributing to the delay to diagnose TB among patients attending KCCA treatment and diagnostic units in the period of July to August 2014.

Methodology A cross sectional study of 281 PTB diagnosed patients was conducted at the 7 public health TB diagnostic and treatment units in Kampala, from July to August 2014.

Quantitative methods of data collection using a researcher administered questionnaire and qualitative methods using focus group discussion and key informant guide were utilized.

Poisson regression model was used to estimate the incidence risk ratios (IRR) and their 95% confidence interval for the delays comparing them with the independent variables.

Results The mean total delay (interval from onset of cough to first contact with the health facility and interval from first contact with health facility to receipt of TB results) was 78 days (S.D =72). 58% of patients often sought care from drug shops or pharmacies before visiting a TB diagnostic and treatment unit (incidence risk ratio [IRR] =1.05; 95% CI: 1.0-1.3). Other factors that contributed to the 'Total delay to diagnose TB' were identified: being unemployed (IRR =1.09; 95% CI: 1.0-1.2), cohabiting (IRR =1.14; 95% CI: 1.0-1.3), never taken alcohol (IRR =0.88; 95% CI: 0.8-1.0), private means of transport (IRR=1.15; 95% CI: 1.0-1.3), and more than three TB clinic visits prior to diagnosis (IRR=1.15; 95% CI: 1.0-1.3). Smoking, HIV status and perceived TB stigma were not associated with total delay in TB diagnosis.

Conclusion Delay in diagnosis of PTB is unacceptably high in Kampala. A huge proportion (86.8%) of patient factors contributed to the delay to diagnose TB than the health care related factors (13.2%). Majority 88.3% (248/281) of PTB patients in Kampala take 78 days from onset of cough to TB diagnosis, a factor that increases the rate of TB transmission, morbidity and mortality.

Recommendations The Uganda NTLP should pay more attention to certain specific groups such as alcoholics and the unemployed in order to improve their health seeking behavior.

TB diagnostic services should be accessible to the general population through community outreaches and contact tracing, so that patients residing more than 5 km from a TB diagnostic unit are diagnosed at home.

KCCA TB focal persons should ensure that TB diagnostic supplies are provided to all TB units in order to avoid stock outs and enhance early diagnosis of TB.

KCCA TB management team should conduct continuous community sensitization to enable patients understand the importance of early diagnosis.

The National Drug Authority should strengthen policies regarding administration of medicines in drug shops/pharmacies without prescription from registered health professionals.

Drug shop/pharmacy employees have to be trained in order to have a high index of suspicion for tuberculosis when cardinal symptoms exist.

Further areas of research should be conducted in order to enhance early TB diagnosis.