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Four Degrees of Separation: Social Contacts and Health Providers Influence the Steps to Final Diagnosis of Active Tuberculosis Patients in Urban Uganda.

Sekandi JN, Zalwango S, Martinez L, Handel A, Kakaire R, Nkwata AK, Ezeamama AE, Kiwanuka N, Whalen CC - BMC Infect. Dis. (2015)

Bottom Line: New patients had more steps and time to diagnosis compared retreatment patients (5 vs. 3, P < 0.0001; 84 vs. 46 days P < 0.0001).New TB patients vs. retreatment (HR: 0.66, 95 % CI; 1.11, 1.99), those who first contacted a non-TB health provider vs. contacting social network (HR: 0.72 95 % CI; 0.55, 0.95) and HIV seronegative vs. seropositive patients (HR: 0.70, 95 % CI; 0.53, 0.92) had a significantly lower likelihood of a timely final diagnosis.Most delays occurred in the first step which represents decisions to seek help, and through interactions with non-TB health providers.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, B.S. Miller Hall, 101 Buck Rd, Athens, GA, 30602, USA. juliet.sekandi5@gmail.com.

ABSTRACT

Background: Delay in tuberculosis (TB) diagnosis adversely affects patients' outcomes and prolongs transmission in the community. The influence of social contacts on steps taken by active pulmonary TB patients to seek a diagnosis has not been well examined.

Methods: A retrospective study design was use to enroll TB patients on treatment for 3 months or less and aged ≥18 years from 3 public clinics in Kampala, Uganda, from March to July 2014. Social network analysis was used to collect information about social contacts and health providers visited by patients to measure the number of steps and time between onset of symptoms and final diagnosis of TB.

Results: Of 294 TB patients, 58 % were male and median age was 30 (IQR: 24-38) years. The median number of steps was 4 (IQR: 3, 7) corresponding to 70 (IQR: 28,140) days to diagnosis. New patients had more steps and time to diagnosis compared retreatment patients (5 vs. 3, P < 0.0001; 84 vs. 46 days P < 0.0001). Fifty-eight percent of patients first contacted persons in their social network. The first step to initiate seeking care accounted for 41 % of the patients' time to diagnosis while visits to non-TB providers and TB providers (without a TB diagnosis) accounted for 34 % and 11 % respectively. New TB patients vs. retreatment (HR: 0.66, 95 % CI; 1.11, 1.99), those who first contacted a non-TB health provider vs. contacting social network (HR: 0.72 95 % CI; 0.55, 0.95) and HIV seronegative vs. seropositive patients (HR: 0.70, 95 % CI; 0.53, 0.92) had a significantly lower likelihood of a timely final diagnosis.

Conclusions: There were four degrees of separation between the onset of symptoms in a TB patient and a final diagnosis. Both social and provider networks of patients influenced the diagnostic pathways. Most delays occurred in the first step which represents decisions to seek help, and through interactions with non-TB health providers. TB control programs should strengthen education and active screening in the community and in health care settings to ensure timely diagnosis of TB.

No MeSH data available.


Related in: MedlinePlus

Percent of TB Patients’ First Contact by TB Treatment Category
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Fig3: Percent of TB Patients’ First Contact by TB Treatment Category

Mentions: The first point of contact was most often with a member of the patients’ social network (Fig. 3); 58 % of all patients initially approached a family member, relative, friend or co-worker for advice or help (Fig. 4). The next most common point of first contact was the non-TB provider networks; 30 % of patients contacted non-TB providers which included private clinics, drug stores, herbal healers or village health care workers. Of these points of contacts, private clinics/drug stores were the most common (Fig. 4). TB care providers were least likely to be visited as initial contact. When we stratified by new or retreatment TB category, the results were similar in direction.Fig. 3


Four Degrees of Separation: Social Contacts and Health Providers Influence the Steps to Final Diagnosis of Active Tuberculosis Patients in Urban Uganda.

Sekandi JN, Zalwango S, Martinez L, Handel A, Kakaire R, Nkwata AK, Ezeamama AE, Kiwanuka N, Whalen CC - BMC Infect. Dis. (2015)

Percent of TB Patients’ First Contact by TB Treatment Category
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4546132&req=5

Fig3: Percent of TB Patients’ First Contact by TB Treatment Category
Mentions: The first point of contact was most often with a member of the patients’ social network (Fig. 3); 58 % of all patients initially approached a family member, relative, friend or co-worker for advice or help (Fig. 4). The next most common point of first contact was the non-TB provider networks; 30 % of patients contacted non-TB providers which included private clinics, drug stores, herbal healers or village health care workers. Of these points of contacts, private clinics/drug stores were the most common (Fig. 4). TB care providers were least likely to be visited as initial contact. When we stratified by new or retreatment TB category, the results were similar in direction.Fig. 3

Bottom Line: New patients had more steps and time to diagnosis compared retreatment patients (5 vs. 3, P < 0.0001; 84 vs. 46 days P < 0.0001).New TB patients vs. retreatment (HR: 0.66, 95 % CI; 1.11, 1.99), those who first contacted a non-TB health provider vs. contacting social network (HR: 0.72 95 % CI; 0.55, 0.95) and HIV seronegative vs. seropositive patients (HR: 0.70, 95 % CI; 0.53, 0.92) had a significantly lower likelihood of a timely final diagnosis.Most delays occurred in the first step which represents decisions to seek help, and through interactions with non-TB health providers.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, B.S. Miller Hall, 101 Buck Rd, Athens, GA, 30602, USA. juliet.sekandi5@gmail.com.

ABSTRACT

Background: Delay in tuberculosis (TB) diagnosis adversely affects patients' outcomes and prolongs transmission in the community. The influence of social contacts on steps taken by active pulmonary TB patients to seek a diagnosis has not been well examined.

Methods: A retrospective study design was use to enroll TB patients on treatment for 3 months or less and aged ≥18 years from 3 public clinics in Kampala, Uganda, from March to July 2014. Social network analysis was used to collect information about social contacts and health providers visited by patients to measure the number of steps and time between onset of symptoms and final diagnosis of TB.

Results: Of 294 TB patients, 58 % were male and median age was 30 (IQR: 24-38) years. The median number of steps was 4 (IQR: 3, 7) corresponding to 70 (IQR: 28,140) days to diagnosis. New patients had more steps and time to diagnosis compared retreatment patients (5 vs. 3, P < 0.0001; 84 vs. 46 days P < 0.0001). Fifty-eight percent of patients first contacted persons in their social network. The first step to initiate seeking care accounted for 41 % of the patients' time to diagnosis while visits to non-TB providers and TB providers (without a TB diagnosis) accounted for 34 % and 11 % respectively. New TB patients vs. retreatment (HR: 0.66, 95 % CI; 1.11, 1.99), those who first contacted a non-TB health provider vs. contacting social network (HR: 0.72 95 % CI; 0.55, 0.95) and HIV seronegative vs. seropositive patients (HR: 0.70, 95 % CI; 0.53, 0.92) had a significantly lower likelihood of a timely final diagnosis.

Conclusions: There were four degrees of separation between the onset of symptoms in a TB patient and a final diagnosis. Both social and provider networks of patients influenced the diagnostic pathways. Most delays occurred in the first step which represents decisions to seek help, and through interactions with non-TB health providers. TB control programs should strengthen education and active screening in the community and in health care settings to ensure timely diagnosis of TB.

No MeSH data available.


Related in: MedlinePlus