Patient-Pathway Analysis of Tuberculosis Services in Cameroon

Abstract

In Cameroon, in 2019, tuberculosis (TB) treatment coverage was estimated at 53%, indicating that almost half of all people sick with TB were not diagnosed or linked to care. To inform strategies to improve access to TB services, we conducted an evaluation of the alignment between patient-initiated care-seeking behavior and spatial and institutional allocation of TB services. Data sources included the Cameroon Demographic and Health Survey (2018), the Health Facility List (2017), and routinely collected TB surveillance data. Data visualization was performed in Tableau and QGIS. The pathway analysis showed that only an estimated 9% of people attended a health facility providing TB services at initial care-seeking, with access varying from <3% to 16% across the ten regions of the country. While 72% of government and 56% of private hospitals (Level 2 facilities) provide TB services, most Cameroonians (87%) initially chose primary care (Level 1) or informal private sector sites (Level 0) without TB services. The gaps were greatest in regions with the highest prevalence of poverty, a significant determinant for TB. These results indicate that access may be improved by expanding TB services at both public and private facilities across the country, prioritizing regions with the greatest gaps.

Keywords: Cameroon; care-seeking; patient-pathway analysis (PPA); tuberculosis.

Figure 1

Visual of the patient-pathway analysis for TB services in Cameroon.

Figure 2

Estimated percentage of people by reported place of initial care-seeking and with access to TB testing and treatment services at initial care-seeking, by health facility level and region.

Figure 3

Comparison of (a) estimated distribution of people in the lowest quintile of the household population (DHS 2018) and (b) estimated percentage of people with access to TB services at initial care-seeking, by geographical region.

Figure 4

Scatter plots comparing TB case notification rates to the (A) average number of health facilities providing TB services and (B) estimated access to TB diagnostic and treatment services at initial care-seeking per 100,000 inhabitants; the size of the circles for each region is proportional to the regional populations.