Factors associated with missed opportunities in TB investigation in public facilities in Wakiso District

Abstract

Introduction Tuberculosis (TB) is a major public health problem in Uganda. The prevalence of TB in Uganda is 273/100,000. Despite the implementation of several interventions to increase TB case detection in Uganda such as increased number of TB Diagnostic and treatment units, increased utilization of GeneXpert for TB diagnosis, chest X-ray, and microscopy, only 16 % of patients with symptoms suggestive of TB receive sputum microscopy or CXR. The missed opportunities in TB investigations in Wakiso district and associated factors are unknown. The study objective has been to determine magnitude of and factors associated with missed opportunities in TB disease investigation at public health facilities in Wakiso District (March-June 2018). Methods This was a cross sectional survey among 10 TB diagnostic and treatment Units in Wakiso District. Data were collected from two hundred forty-seven (247) patients and 10 key informants. Quantitative data were analyzed using STATA and modified Poisson regression to determine factors significantly associated with missed opportunities in TB investigation. Qualitative data was analysed using a content analysis technique. Results Sputum and/or CXR were not requested from majority, 138/247 (55.9%) of the patients with symptoms suggestive of TB disease. Patients who did not inform health workers about the symptoms were 1.68 times more likely to miss TB investigations (APR; 1.68, 95%CI; 1.36-2.08, P=0.000). High patient load and limited number of skilled health workers hindered TB investigation. Conclusion; The missed opportunities in TB investigation were high. Patients who did not inform health workers about their symptoms were more likely to be missed out. Strengthening competencies of existing health workers, increasing numbers of highly skilled staff in TB management at all entry care points and increased TB sensitization among population will improve TB investigations and reduce missed opportunities.