Tuberculosis screening and associated factors among patients in the outpatient department of Moyo hospital, Uganda.

Abstract

Introduction: There is evidence that many TB patients present at health facilities but they are not identified, resulting in missed cases. Globally, about 4.3 million TB patients were not diagnosed or reported by the national TB programs in 2015. In Uganda, about 90% of patients with TB symptoms were not screened. TB Screening is aimed at identifying and treating TB as early as possible to reduce the period of transmission. Therefore, we conducted this study to assess TB screening and associated factors among OPD patients in Moyo Hospital. Methods: A concurrent mixed method design was conducted between Jan and Feb 2020 in Moyo Hospital after approval of the study by the IRB. A total of 615 OPD patients and eight HCWs involved in TB screening were selected using systematic and criterion methods. Data on barriers to TB screening was collected using interviews and observation. Sociodemographic and clinical data were collected using document review and entered into EPIDATA manager and analyzed using STATA version 13. Modified Poisson was used for the analysis. The adjusted prevalence ratio was calculated. P-value <0.05 was considered statistically significant. Audio recordings from the interviews were transcribed verbatim and analyzed using inductive content analysis to identify themes. Results: The prevalence of TB screening was 49% (95% CI; (44.8-52.7). Older age (PR= 1.465, 95% CI:1.251, 1.717), clinical feature reported (PR= 0.360, 95% CI:0.283, 0.459), HIV results (PR=0.567, 95% CI: 0.414, 0.775) and diabetes results (PR= 0.308, 95% CI:0.244, 0.389) were the significant factors associated with TB screening. Barriers to effective TB screening included inadequate human resource, poor attitude of health workers, fear of contracting TB, lack of motivation, and lack of adherence to the intensified case finding guide Conclusions: The prevalence of TB screening among OPD patients was very low. Our findings suggest that health facility and health worker factors work together to delay TB screening and, if not addressed, could hinder TB case detection efforts. Regular refresher training and enforcing adherence to the ICF guide are needed to improve TB suspicion index at the OPD.