Missed opportunity for tuberculosis identification among patients presenting at Bubulo health centre iv and Butiru health centre III in Manafwa district.

Abstract

Background: Missed Tuberculosis (TB) screening opportunities are key drivers for continued Tuberculosis transmission. Although Uganda national TB guideline recommend universal TB screening of all individuals presenting to health facilities, TB screening continue to be missed with (45-50%) of the incident TB cases missed annually. The study was carried out at Bubulo health centre IV and Butiru health centre III to determine the proportion of, and factors associated with missing TB screening, and explore facilitators and barriers associated with TB screening among health workers in Manafwa district in order to inform future TB prevention and control efforts in Uganda.

Materials and Methods: This was a facility based, mixed-method, cross-sectional study. For quantitative component, systematic random sampling was employed, an exit patient interview was used to collect data electronically using Kobo-Collect tool. STATA version 15 was used to analyze quantitative data, univariate data was summarized in tables in form of frequencies, percentages and totals. Clustering at study facility level was factored in at both bivariate and multivariate analysis using a Binary logistic regression model to test for study hypothesizes at 95% confidence interval. For the qualitative component, participants were purposively selected; data were collected with the use of a key informant interview guide using an audio recorder. Transcription in form of text was done and data imported into Nvivo version 12 software for organizing, coding and themes generation. Both deductive and inductive approaches were used to analyze qualitative data. Ethical approval was sought from Mbale Regional Referral Hospital Research Ethics Committee (REC) before data collection.

Results: A total of 125 patients were enrolled into the study from the two health facilities and the response rate was 100%. Of the 125 participants enrolled into the study, 68% (n=85) missed TB screening. The factors associated with missing TB Screening were; awareness about TB symptoms (adjusted Odds Ratio [AOR] 6.81; 95% Confidence Interval [95%CI]: 6.60-7.02) and study site (AOR 67.57; 95% CI: 30.99-147.33). The major facilitators for TB screening included; adequate and dedicated health work force and TB training, availability of TB screening tools and guidelines and availability of adequate medical supplies. Understaffing and absenteeism, inadequate knowledge of health workers, fear and stigma among health workers, long waiting time and inadequate medical supplies were the major barriers to TB screening. Conclusion: There was a big proportion of patients who missed TB screening at the two study. Limited awareness about TB symptoms among patients and study site was significantly associated with missing TB screening. It was also noted that well trained health workforce, availability of TB screening resources and medical supplies were among the major facilitators for TB screening while human resource and health facility related factors were among the barriers that affect TB screening.