Abstract
Ghana's national prevalence survey showed higher than expected tuberculosis (TB) prevalence, indicating that many people with TB are not identified and treated. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment. A prospective cohort study was conducted in urban and rural health facilities in south-east Ghana. Consecutive patients routinely identified as needing a TB test were followed up for two months to find out if sputum was submitted and/or treatment started. The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression. A total of 428 persons (mean age 48 years, 67.3% female) were recruited, 285 (66.6%) from urban and 143 (33.4%) from rural facilities. Of 410 (96%) individuals followed up, 290 (70.7%) submitted sputum, among which 27 (14.1%) had a positive result and started treatment. Among those who visited an urban facility, 245/267(91.8%) submitted sputum, compared to 45/143 (31.5%) who visited a rural facility. Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84-42.51). After adjustment for confounding, there was still a strong association between attending the urban facility and submitting sputum (adjusted OR (aOR) 9.52, 95%CI 3.87-23.40). Travel distance of >10 km to the laboratory was the strongest predictor of not submitting sputum (aOR 0.12, 95%CI 0.05-0.33). The majority of presumptive TB patients attending a rural health facility did not submit sputum for testing, mainly due to the long travel distance to the laboratory. Bridging this gap in the diagnostic cascade may improve case detection.
Highlights
The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression
Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84– 42.51)
Ghana is one of the tuberculosis (TB) and human immunodeficiency virus (HIV) high burden countries according to the World Health Organization (WHO) [1]
Summary
Ghana is one of the tuberculosis (TB) and human immunodeficiency virus (HIV) high burden countries according to the World Health Organization (WHO) [1]. Ghana’s national TB prevalence survey highlighted weaknesses in the care cascade where of persons with prolonged cough who visited a health facility, only 25% submitted sputum for testing [4]. In Ghana, TB diagnosis and treatment is mainly done at government health facilities. A person with symptoms of TB might be identified at a health centre but will have to travel themselves to the district hospital for a sputum test to confirm the diagnosis. This creates an obstacle to diagnosis and treatment and potential loss within the cascade of TB care. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
