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. 2018 Nov 21:31:196.
doi: 10.11604/pamj.2018.31.196.15848. eCollection 2018.

Does pre-diagnostic loss to follow-up among presumptive TB patients differ by type of health facility? An operational research from Hwange, Zimbabwe in 2017

Munekayi Padingani  1 , Ajay Kumar  2   3 , Jaya Prasad Tripathy  2   3 , Nyasha Masuka  1 , Sidingiliswe Khumalo  1
Affiliations

Does pre-diagnostic loss to follow-up among presumptive TB patients differ by type of health facility? An operational research from Hwange, Zimbabwe in 2017

Munekayi Padingani et al. Pan Afr Med J. .

Abstract

Introduction: While there are many studies assessing the pre-treatment loss to follow-up (LFU) among tuberculosis patients in public sector, there is no evidence from private-for-profit health sector and pre-diagnostic LFU from Zimbabwe. We aimed to assess the gaps in the cascade of care of presumptive TB patients registered during January-June 2017 in different types of health facilities in Hwange district, Zimbabwe.

Methods: This was a cohort study involving review of routine programme data. Pre-diagnostic LFU was defined as the proportion of presumptive TB patients not tested using sputum microscopy or Xpert MTB/RIF. A log binomial regression was done to assess factors associated with pre-diagnostic LFU.

Results: Of 1279 presumptive TB patients, 955(75%) were tested for TB and 102(8%) were diagnosed as having TB. All TB patients were started on treatment. Pre-diagnostic LFU (overall 25%) was significantly higher among patients visiting private-for-profit health facilities (36%), local self-government run council health facilities (35%) and church-run mission health facilities (25%) compared to government health facilities (14%). Pre-diagnostic LFU was significantly higher among patients in rural areas (30%) compared to urban areas (18%). Type of health facility was associated with pre-diagnostic LFU after adjusting for HIV status and area of residence.

Conclusion: While pre-diagnostic LFU was high, there was no pre-treatment LFU. Pre-diagnostic LFU was especially high in private-for-profit and council health facilities and rural areas. National TB Programme should take immediate steps to improve access in rural areas and support the private-for-profit and council health facilities by improving sputum collection and transport.

Keywords: Pre-diagnostic loss to follow up; SORT IT; attrition; initial default; operational research; pre-treatment loss to follow-up; public-private-for-profit mix.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
TB diagnostic and treatment cascade among presumptive TB patients registered health facilities of Hwange district, Zimbabwe, 2017
See this image and copyright information in PMC

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