Health-seeking behaviour of human brucellosis cases in rural Tanzania

John Kunda,Nigel P French,Alastair Macmillan,Dominic Kambarage,Julie Fitzpatrick,Mark Bronsvoort,Gabriel Shirima,Sarah Cleaveland,Rudovic Kazwala

doi:10.1186/1471-2458-7-315

Abstract

BackgroundBrucellosis is known to cause debilitating conditions if not promptly treated. In some rural areas of Tanzania however, practitioners give evidence of seeing brucellosis cases with symptoms of long duration. The purpose of this study was to establish health-seeking behaviour of human brucellosis cases in rural Tanzania and explore the most feasible ways to improve it.MethodsThis was designed as a longitudinal study. Socio-demographic, clinical and laboratory data were collected from patients who reported to selected hospitals in rural northern Tanzania between June 2002 and April 2003. All patients with conditions suspicious of brucellosis on the basis of preliminary clinical examination and history were enrolled into the study as brucellosis suspects. Blood samples were taken and tested for brucellosis using the Rose-Bengal Plate Test (RBPT) and other agglutination tests available at the health facilities and the competitive ELISA (c-ELISA) test at the Veterinary Laboratory Agencies (VLA) in the UK. All suspects who tested positive with the c-ELISA test were regarded as brucellosis cases. A follow-up of 49 cases was made to collect data on health-seeking behaviour of human brucellosis cases.ResultsThe majority of cases 87.7% gave a history of going to hospital as the first point of care, 10.2% purchased drugs from a nearby drug shop before going to hospital and 2% went to a local traditional healer first. Brucellosis cases delayed going to hospital with a median delay time of 90 days, and with 20% of the cases presenting to hospitals more than a year after the onset of symptoms. Distance to the hospital, keeping animals and knowledge of brucellosis were significantly associated with patient delay to present to hospital.ConclusionMore efforts need to be put on improving the accessibility of health facilities to the rural poor people who succumb to most of the diseases including zoonoses. Health education on brucellosis in Tanzania should also stress the importance of early presentation to hospitals for prompt treatment.

Highlights

Brucellosis is known to cause debilitating conditions if not promptly treated
Of the 1586 samples that were collected from suspected brucellosis patients over a ten-month period and sent to Veterinary Laboratory Agencies (VLA) for the competitive Enzyme-Linked immunosorbent Assays (ELISA) (c-ELISA) test, 98 (6.2%) tested positive for brucellosis
Health system delay was a result of false negative results causing a failure to diagnose 22 (44.8%) cases of brucellosis on their first visits to hospitals

Summary

Introduction

Brucellosis is known to cause debilitating conditions if not promptly treated. In some rural areas of Tanzania practitioners give evidence of seeing brucellosis cases with symptoms of long duration. The multiple and non-specific features of brucellosis contribute to difficulties in the diagnosis of brucellosis in areas where diseases with similar clinical features such as malaria, tuberculosis, typhoid and joint diseases co-exist [1,2]. In many sub-Sahara African countries, febrile or flu-like conditions with similar manifestations occur commonly and have significantly contributed to difficulties in the diagnoses of such diseases as brucellosis, typhoid, malaria, amoeba and tuberculosis [5,6]. In Kampala, Uganda, of patients with joint pain, general malaise, and/or constant headache, 73% were found to be suffering from malaria and 13.3% from brucellosis [5]

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