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Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems
Jennifer M. Ross
Jennifer M. Ross
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
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Adithya Cattamanchi
Adithya Cattamanchi
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
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Cecily R. Miller
Cecily R. Miller
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
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Andrew J. Tatem
Andrew J. Tatem
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
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Achilles Katamba
Achilles Katamba
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
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Priscilla Haguma
Priscilla Haguma
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
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Margaret A. Handley
Margaret A. Handley
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
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J. Lucian Davis
J. Lucian Davis
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
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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.
Author Notes
Funding supports: Jennifer M. Ross acknowledges funding support from NIH/NIAID (T32AI007140). Andrew J. Tate acknowledges funding support from the RAPIDD program of the Science and Technology Directorate, Department of Homeland Security, and the Fogarty International Center, National Institutes of Health, and is also supported by grants from NIH/NIAID (U19AI089674) and the Bill and Melinda Gates Foundation (#49446 and #1032350). J. Lucian Davis acknowledges support from NIH/NIAID (K23AI080147). Adithya Cattamanchi acknowledges support from NIH/NHLBI (K23HL094141).
Authors' addresses: Jennifer M. Ross, Division of Infectious Diseases, University of Washington, Seattle, WA, E-mail: jross3@uw.edu. Adithya Cattamanchi and Cecily R. Miller, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, E-mails: acattamanchi@medsfgh.ucsf.edu and cecily.miller@ucsf. J. Lucian Davis, 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, CT, E-mail: lucian.davis@yale.edu. Andrew J. Tatem, Department of Geography and Environment, University of Southampton, Southampton, United Kingdom, E-mail: andy.tatem@gmail.com. Achilles Katamba, College of Health Sciences, Makerere University, Kampala, Uganda, E-mail: akatamba@yahoo.com. Priscilla Haguma, MU-UCSF Research Collaboration, Kampala, Uganda, E-mail: phaguma@idrc-uganda.org. Margaret A. Handley, Department of Epidemiology and Biostatistics, UCSF School of Medicine, San Francisco, CA, E-mail: handleym@medsfgh.ucsf.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
WHO, 2011. The Global Plan to Stop TB 2011–2015: Transforming the Fight Towards Elimination of Tuberculosis. Geneva, Switzerland: WHO.
-
2.
Kemp J, Squire S, Nyirenda I, Salaniponi F, 1996. Is tuberculosis diagnosis a barrier to care? Trans R Soc Trop Med Hyg 90: 472.
-
3.
Botha E, den Boon S, Lawrence KA, Reuter H, Verver S, Lombard CJ, Dye C, Enarson DA, Beyers N, 2008. From suspect to patient: tuberculosis diagnosis and treatment initiation in health facilities in South Africa. Int J Tuberc Lung Dis 12: 936–941.
-
4.
Squire SB, Belaye AK, Kashoti A, Salaniponi FM, Mundy CJ, Theobald S, Kemp J, 2005. ‘Lost’ smear-positive pulmonary tuberculosis cases: where are they and why did we lose them? Int J Tuberc Lung Dis 9: 25–31.
-
5.
Botha E, Den Boon S, Verver S, Dunbar R, Lawrence KA, Bosman M, Enarson DA, Toms I, Beyers N, 2008. Initial default from tuberculosis treatment: how often does it happen and what are the reasons? Int J Tuberc Lung Dis 12: 820–823.
-
6.
World Health Organization, 2011. Same-day Diagnosis of Tuberculosis by Microscopy. Geneva, Switzerland: WHO.
-
7.
Davis JL, Cattamanchi A, Cuevas LE, Hopewell PC, Steingart KR, 2013. Diagnostic accuracy of same-day microscopy versus standard microscopy for pulmonary tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis 13: 147–154.
-
8.
Finnie RK, Khoza LB, van den Borne B, Mabunda T, Abotchie P, Mullen PD, 2011. Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub-Saharan African countries with high burdens of TB and HIV. Trop Med Int Health 16: 394–411.
-
9.
Houben RM, Van Boeckel TP, Mwinuka V, Mzumara P, Branson K, Linard C, Chimbwandira F, French N, Glynn JR, Crampin AC, 2012. Monitoring the impact of decentralised chronic care services on patient travel time in rural Africa–methods and results in northern Malawi. Int J Health Geogr 11: 49.
-
10.
Huerta Munoz U, Kallestal C, 2012. Geographical accessibility and spatial coverage modeling of the primary health care network in the Western Province of Rwanda. Int J Health Geogr 11: 40.
-
11.
Sudhof L, Amoroso C, Barebwanuwe P, Munyaneza F, Karamaga A, Zambotti G, Drobac P, Hirschhorn LR, 2013. Local use of Geographic Information Systems to improve data utilisation and health services: mapping caesarean section coverage in rural Rwanda. Trop Med Int Health 18: 18–26.
-
12.
Alegana VA, Wright JA, Pentrina U, Noor AM, Snow RW, Atkinson PM, 2012. Spatial modelling of healthcare utilisation for treatment of fever in Namibia. Int J Health Geogr 11: 6.
-
13.
Noor AM, Amin AA, Gething PW, Atkinson PM, Hay SI, Snow RW, 2006. Modelling distances travelled to government health services in Kenya. Trop Med Int Health 11: 188–196.
-
14.
Gabrysch S, Cousens S, Cox J, Campbell OM, 2011. The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Med 8: e1000394.
-
15.
Guagliardo MF, 2004. Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr 3: 3.
-
16.
Blanford JI, Kumar S, Luo W, MacEachren AM, 2012. It's a long, long walk: accessibility to hospitals, maternity and integrated health centers in Niger. Int J Health Geogr 11: 24.
-
17.
World Health Organization, 2001. Background Paper for the Technical Consultation on Effective Coverage of Health Systems. Geneva, Switzerland: WHO.
-
18.
Miller CR, Davis JL, Katamba A, Sserwanga A, Kakeeto S, Kizito F, Cattamanchi A, 2013. Sex disparities in tuberculosis suspect evaluation: a cross-sectional analysis in rural Uganda. Int J Tuberc Lung Dis 17: 480–485.
-
19.
Davis J, Katamba A, Vasquez J, Crawford E, Sserwanga A, Kakeeto S, Kizito F, Dorsey G, den Boon S, Vittinghoff E, Huang L, Adatu F, Kamya MR, Hopewell PC, Cattamanchi A, 2011. Evaluating tuberculosis case detection via real-time monitoring of tuberculosis diagnostic services. Am J Respir Crit Care Med 184: 362–367.
-
20.
Uganda Bureau of Statistics, 2006. The 2002 Uganda Population and Housing Census, Population Size and Distribution. Kampala, Uganda: Uganda Bureau of Statistics.
-
21.
Hopewell PC, Pai M, Maher D, Uplekar M, Raviglione MC, 2006. International standards for tuberculosis care. Lancet Infect Dis 6: 710–725.
-
22.
Global Administrative Areas, 2012. GADM Database of Global Administrative Areas. Available at: www.gadm.org. Accessed December 12, 2011.
-
23.
Shuttle Radar Topography Mission (SRTM), 2011. U.S. Releases Enchanced Shuttle Land Elevation Data. Available at: http://www2.jpl.nasa.gov/srtm/. Accessed December 12, 2011.
-
24.
Di Gregorio A. Multipurpose Landcover Database of Uganda - AFRICOVER. United Nations Food and Agriculture Organization, 2003. Available at: http://www.glcn.org/index_en.jsp. Accessed December 12, 2011.
-
25.
Center for International Earth Science Information Network - CIESIN - Columbia University, and Information Technology Outreach Services - ITOS - University of Georgia, 2013. Global Roads Open Access Data Set, Version 1 (gROADSv1). Palisades, NY: NASA Socioeconomic Data and Applications Center (SEDAC). Available at: http://dx.doi.org/10.7927/H4VD6WCT. Accessed December 12, 2011.
-
26.
National Imagery and Mapping Agency (NIMA), 2000. Vector Map Level 0 (VMAP0). Available at: http://earth-info.nga.mil/publications/vmap0.html. Accessed December 12, 2011.
-
27.
Nelson A, 2008. Estimated Travel Time to the Nearest City of 50,000 or More People in Year 2000. Global Environment Monitoring Unit - Joint Research Centre of the European Commission. Available at: http://forobs.jrc.ec.europa.eu/products/gam/.
-
28.
Bland JM, Altman DG, 1996. Measurement error proportional to the mean. BMJ 313: 106.
-
29.
Dewitte K, Fierens C, Stockl D, Thienpont LM, 2002. Application of the Bland–Altman plot for interpretation of method-comparison studies: a critical investigation of its practice. Clin Chem 48: 799–801.
-
30.
WorldPop, 2013. Uganda Population Map - 2010. Available at: http://www.worldpop.org. Accessed March 11, 2015.
-
31.
Akaike H, 1974. A new look at the statistical model identification. IEEE Trans Automat Contr 19: 716–723.
-
32.
Ross J, Cattamanchi A, Miller C, Katamba A, Davis J, 2012. Using geographic analysis to investigate barriers to TB evaluation in Uganda. American Thoracic Society International Conference. New York.
-
33.
National Geospatial-Intelligence Agency. NGA GEOnet Names Server. Available at: http://geonames.nga.mil/gns/html/namefiles.html. Accessed December 2011.
-
34.
Khan AJ, Khowaja S, Khan FS, Qazi F, Lotia I, Habib A, Mohammed S, Khan U, Amanullah F, Hussain H, Becerra MC, Creswell J, Keshavjee S, 2012. Engaging the private sector to increase tuberculosis case detection: an impact evaluation study. Lancet Infect Dis 12: 608–616.
-
35.
Kunawararak P, Pongpanich S, Chantawong S, Pokaew P, Traisathit P, Srithanaviboonchai K, Plipat T, 2011. Tuberculosis treatment with mobile-phone medication reminders in northern Thailand. Southeast Asian J Trop Med Public Health 42: 1444–1451.
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