Geographic distribution and predictors of diagnostic delays among possible TB patients in Uganda.

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2023-09-21 DOI:10.5588/pha.23.0010

E Ochom, K O Robsky, A J Gupta, A Tamale, J Kungu, P Turimumahoro, S Nakasendwa, I B Rwego, W Muttamba, M Joloba, W Ssengooba, J L Davis, A Katamba

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Abstract

Background: Understanding the geographic distribution and factors associated with delayed TB diagnosis may help target interventions to reduce delays and improve patient outcomes.

Methods: We conducted a secondary analysis of adults undergoing TB evaluation within a public health demonstration project in Uganda. Using Global Moran's I (GMI) and Getis-Ord GI* statistics, we evaluated for residential clustering and hotspots associated with patient-related and health system-related delays. We performed multivariate logistic regression to identify individual predictors of both types of delays.

Results: Of 996 adults undergoing TB evaluation (median age: 37 years, IQR 28-49), 333 (33%) experienced patient delays, and 568 (57%) experienced health system delays. Participants were clustered (GMI 0.47-0.64, P ⩽ 0.001) at the sub-county level, but there were no statistically significant hotspots for patient or health system delays. Married individuals were less likely to experience patient delays (OR 0.6, 95% CI 0.48-0.75; P < 0.001). Those aged 38-57 years (OR 1.2, 95% CI 1.07-1.38; P = 0.002) were more likely than those aged ⩾58 years to experience patient delays. Knowledge about TB (OR 0.8, 95% CI 0.63-0.98; P = 0.03) protected against health system delays.

Conclusions: We did not identify geographic hotspots for TB diagnostic delays. Instead, delays were associated with individual factors such as age, marital status and TB knowledge.

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乌干达可能的结核病患者诊断延误的地理分布和预测因素。

背景：了解结核病延迟诊断的地理分布和相关因素可能有助于有针对性的干预措施，以减少延迟并改善患者的预后。方法：我们在乌干达的一个公共卫生示范项目中对接受结核病评估的成年人进行了二次分析。使用Global Moran’s I（GMI）和Getis Ord GI*统计数据，我们评估了与患者相关和卫生系统相关延迟相关的住宅集群和热点。我们进行了多变量逻辑回归，以确定两种类型延迟的个体预测因素。结果：在996名接受结核病评估的成年人（中位年龄：37岁，IQR 28-49）中，333人（33%）经历了患者延误，568人（57%）经历了卫生系统延误。参与者在次县一级进行了聚类（GMI 0.47-0.64，P⩽0.001），但没有患者或卫生系统延误的统计显著热点。已婚个体不太可能经历患者延误（OR 0.6，95%CI 0.48-0.75；P<0.001）。38-57岁的个体（OR 1.2，95%CI 1.07-1.38；P=0.002）比58岁的个体更有可能经历患者延迟。对结核病的了解（OR 0.8，95%CI 0.63-0.98；P=0.03）可防止卫生系统延误。结论：我们没有确定结核病诊断延误的地理热点。相反，延误与年龄、婚姻状况和结核病知识等个人因素有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.