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Free Content Pathways and costs of care for patients with tuberculosis symptoms in rural Uganda

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SETTING: Six district-level government health centers in rural Uganda and the surrounding communities.

OBJECTIVE: To determine pathways to care and associated costs for patients with chronic cough referred for tuberculosis (TB) evaluation in Uganda.

DESIGN: We conducted a cross-sectional study, surveying 64 patients presenting with chronic cough and undergoing first-time sputum evaluation at government clinics. We also surveyed a random sample of 114 individuals with chronic cough in surrounding communities. We collected information on previous health visits for the cough as well as costs associated with the current visit.

RESULTS: Eighty per cent of clinic patients had previously sought care for their cough, with a median of three previous visits (range 0–32, interquartile range [IQR] 2–5). Most (n = 203, 88%) visits were to a health facility that did not provide TB microscopy services, and the majority occurred in the private sector. The cost of seeking care for the current visit alone represented 28.8% (IQR 9.1–109.5) of the patients' median monthly household income.

CONCLUSION: Most patients seek health care for chronic cough, but do so first in the private sector. Engagement of the private sector and streamlining TB diagnostic evaluation are critical for improving case detection and meeting global TB elimination targets.
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Keywords: care seeking; cost; cough; delay; diagnosis

Document Type: Research Article

Affiliations: 1: *Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA 2: Infectious Diseases Research Collaboration, Kampala, Uganda 3: §Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA 4: Infectious Diseases Research Collaboration, Kampala, Uganda, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda 5: *Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA

Publication date: August 1, 2015

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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