Where Are Patients Missed in the Tuberculosis Diagnostic Cascade? A Prospective Cohort Study in Ghana

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2020 Mar 20

PMID 32191768

Citations 8

Authors

Joyce B Der

Daniel Grint

Clement T Narh

Frank Bonsu

Alison D Grant

Affiliations

Soon will be listed here.

Abstract

Background: Ghana's national prevalence survey showed higher than expected tuberculosis (TB) prevalence, indicating that many people with TB are not identified and treated. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment.

Methods: A prospective cohort study was conducted in urban and rural health facilities in south-east Ghana. Consecutive patients routinely identified as needing a TB test were followed up for two months to find out if sputum was submitted and/or treatment started. The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression.

Results: A total of 428 persons (mean age 48 years, 67.3% female) were recruited, 285 (66.6%) from urban and 143 (33.4%) from rural facilities. Of 410 (96%) individuals followed up, 290 (70.7%) submitted sputum, among which 27 (14.1%) had a positive result and started treatment. Among those who visited an urban facility, 245/267(91.8%) submitted sputum, compared to 45/143 (31.5%) who visited a rural facility. Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84-42.51). After adjustment for confounding, there was still a strong association between attending the urban facility and submitting sputum (adjusted OR (aOR) 9.52, 95%CI 3.87-23.40). Travel distance of >10 km to the laboratory was the strongest predictor of not submitting sputum (aOR 0.12, 95%CI 0.05-0.33).

Conclusion: The majority of presumptive TB patients attending a rural health facility did not submit sputum for testing, mainly due to the long travel distance to the laboratory. Bridging this gap in the diagnostic cascade may improve case detection.

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References

Crooks V, Waller S, Smith T, Hahn T . The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. J Gerontol. 1991; 46(4):M139-44. DOI: 10.1093/geronj/46.4.m139. View

Naidoo P, Theron G, Rangaka M, Chihota V, Vaughan L, Brey Z . The South African Tuberculosis Care Cascade: Estimated Losses and Methodological Challenges. J Infect Dis. 2017; 216(suppl_7):S702-S713. PMC: 5853316. DOI: 10.1093/infdis/jix335. View

Duko B, Bedaso A, Ayano G, Yohannis Z . Perceived Stigma and Associated Factors among Patient with Tuberculosis, Wolaita Sodo, Ethiopia: Cross-Sectional Study. Tuberc Res Treat. 2019; 2019:5917537. PMC: 6521372. DOI: 10.1155/2019/5917537. View

Mugauri H, Shewade H, Dlodlo R, Hove S, Sibanda E . Bacteriologically confirmed pulmonary tuberculosis patients: Loss to follow-up, death and delay before treatment initiation in Bulawayo, Zimbabwe from 2012-2016. Int J Infect Dis. 2018; 76:6-13. DOI: 10.1016/j.ijid.2018.07.012. View

Pala S, Bhattacharya H, Lynrah K, Sarkar A, Boro P, Medhi G . Loss to follow up during diagnosis of presumptive pulmonary tuberculosis at a tertiary care hospital. J Family Med Prim Care. 2019; 7(5):942-945. PMC: 6259514. DOI: 10.4103/jfmpc.jfmpc_161_18. View

Daftary A, Frick M, Venkatesan N, Pai M . Fighting TB stigma: we need to apply lessons learnt from HIV activism. BMJ Glob Health. 2017; 2(4):e000515. PMC: 5717927. DOI: 10.1136/bmjgh-2017-000515. View

Osei E, Akweongo P, Binka F . Factors associated with DELAY in diagnosis among tuberculosis patients in Hohoe Municipality, Ghana. BMC Public Health. 2015; 15:721. PMC: 4517499. DOI: 10.1186/s12889-015-1922-z. View

Afutu F, Zachariah R, Hinderaker S, Ntoah-Boadi H, Obeng E, Bonsu F . High initial default in patients with smear-positive pulmonary tuberculosis at a regional hospital in Accra, Ghana. Trans R Soc Trop Med Hyg. 2012; 106(8):511-3. DOI: 10.1016/j.trstmh.2012.05.002. View

Quattrocchi A, Barchitta M, Nobile C, Prato R, Sotgiu G, Casuccio A . Determinants of patient and health system delay among Italian and foreign-born patients with pulmonary tuberculosis: a multicentre cross-sectional study. BMJ Open. 2018; 8(8):e019673. PMC: 6078265. DOI: 10.1136/bmjopen-2017-019673. View

10.

Abebe G, Deribew A, Apers L, Woldemichael K, Shiffa J, Tesfaye M . Knowledge, health seeking behavior and perceived stigma towards tuberculosis among tuberculosis suspects in a rural community in southwest Ethiopia. PLoS One. 2010; 5(10):e13339. PMC: 2952624. DOI: 10.1371/journal.pone.0013339. View

11.

Bogale S, Diro E, Shiferaw A, Yenit M . Factors associated with the length of delay with tuberculosis diagnosis and treatment among adult tuberculosis patients attending at public health facilities in Gondar town, Northwest, Ethiopia. BMC Infect Dis. 2017; 17(1):145. PMC: 5307798. DOI: 10.1186/s12879-017-2240-0. View

12.

Ali S, Naureen F, Noor A, Fatima I, Viney K, Ishaq M . Loss-to-follow-up and delay to treatment initiation in Pakistan's national tuberculosis control programme. BMC Public Health. 2018; 18(1):335. PMC: 5845151. DOI: 10.1186/s12889-018-5222-2. View

13.

De Schacht C, Mutaquiha C, Faria F, Castro G, Manaca N, Manhica I . Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique. PLoS One. 2019; 14(7):e0219470. PMC: 6619801. DOI: 10.1371/journal.pone.0219470. View

14.

Chakrabartty A, Basu P, Ali K, Sarkar A, Ghosh D . Tuberculosis related stigma and its effect on the delay for sputum examination under the Revised National Tuberculosis Control Program in India. Indian J Tuberc. 2018; 65(2):145-151. DOI: 10.1016/j.ijtb.2017.08.032. View

15.

Onyoh E, Kuaban C, Lin H . Pre-treatment loss to follow-up of pulmonary tuberculosis patients in two regions of Cameroon. Int J Tuberc Lung Dis. 2018; 22(4):378-384. DOI: 10.5588/ijtld.17.0676. View

16.

MacPherson P, Houben R, Glynn J, Corbett E, Kranzer K . Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis. Bull World Health Organ. 2014; 92(2):126-38. PMC: 3949536. DOI: 10.2471/BLT.13.124800. View

17.

Mhalu G, Weiss M, Hella J, Mhimbira F, Mahongo E, Schindler C . Explaining patient delay in healthcare seeking and loss to diagnostic follow-up among patients with presumptive tuberculosis in Tanzania: a mixed-methods study. BMC Health Serv Res. 2019; 19(1):217. PMC: 6451234. DOI: 10.1186/s12913-019-4030-4. View

18.

Shewade H, Nair D, Klinton J, Parmar M, Lavanya J, Murali L . Low pre-diagnosis attrition but high pre-treatment attrition among patients with MDR-TB: An operational research from Chennai, India. J Epidemiol Glob Health. 2017; 7(4):227-233. PMC: 7384575. DOI: 10.1016/j.jegh.2017.07.001. View

19.

Shiferaw M, Zegeye A . Delay in tuberculosis diagnosis and treatment in Amhara state, Ethiopia. BMC Health Serv Res. 2019; 19(1):232. PMC: 6469046. DOI: 10.1186/s12913-019-4056-7. View

20.

Saqib S, Ahmad M, Amezcua-Prieto C, Virginia M . Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program. Am J Trop Med Hyg. 2018; 99(1):143-149. PMC: 6085810. DOI: 10.4269/ajtmh.18-0001. View