Ross Jennifer M, Cattamanchi Adithya, Miller Cecily R, Tatem Andrew J, Katamba Achilles, Haguma Priscilla, Handley Margaret A, Davis J Lucian
Division of Infectious Diseases, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco, California; Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; MU-UCSF Research Collaboration, Clinical Epidemiology Unit, Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, Connecticut
Division of Infectious Diseases, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco, California; Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; MU-UCSF Research Collaboration, Clinical Epidemiology Unit, Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, Connecticut.
Am J Trop Med Hyg. 2015 Oct;93(4):733-8. doi: 10.4269/ajtmh.14-0754. Epub 2015 Jul 27.
Reducing geographic barriers to tuberculosis (TB) care is a priority in high-burden countries where patients frequently initiate, but do not complete, the multi-day TB evaluation process. Using routine cross-sectional study from six primary-health clinics in rural Uganda from 2009 to 2012, we explored whether geographic barriers affect completion of TB evaluation among adults with unexplained chronic cough. We measured distance from home parish to health center and calculated individual travel time using a geographic information systems technique incorporating roads, land cover, and slope, and measured its association with completion of TB evaluation. In 264,511 patient encounters, 4,640 adults (1.8%) had sputum smear microscopy ordered; 2,783 (60%) completed TB evaluation. Median travel time was 68 minutes for patients with TB examination ordered compared with 60 minutes without (P < 0.010). Travel time differed between those who did and did not complete TB evaluation at only one of six clinics, whereas distance to care did not differ at any of them. Neither distance nor travel time predicted completion of TB evaluation in rural Uganda, although limited detail in road and village maps restricted full implementation of these mapping techniques. Better data are needed on geographic barriers to access clinics offering TB services to improve TB diagnosis.
在结核病负担较重的国家，减少结核病治疗的地理障碍是一项优先任务，在这些国家，患者经常开始，但未完成，为期多天的结核病评估过程。利用2009年至2012年乌干达农村地区六个初级卫生诊所的常规横断面研究，我们探讨了地理障碍是否会影响原因不明的慢性咳嗽成人完成结核病评估。我们测量了从家乡教区到卫生中心的距离，并使用结合道路、土地覆盖和坡度的地理信息系统技术计算了个人旅行时间，并测量了其与结核病评估完成情况的关联。在264,511次患者就诊中，4,640名成年人（1.8%）接受了痰涂片显微镜检查；2,783人（60%）完成了结核病评估。接受结核病检查的患者的中位旅行时间为68分钟，而未接受检查的患者为60分钟（P < 0.010）。仅在六个诊所中的一个诊所，完成和未完成结核病评估的患者之间的旅行时间有所不同，而到医疗机构的距离在任何一个诊所中都没有差异。在乌干达农村地区，距离和旅行时间都不能预测结核病评估的完成情况，尽管道路和村庄地图的细节有限限制了这些绘图技术的全面实施。需要更好的数据来了解获取结核病服务诊所的地理障碍，以改善结核病诊断。
