Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems

Area of Science:

• Public Health
• Epidemiology
• Geographic Information Systems (GIS)

Background:

• Reducing geographic barriers to tuberculosis (TB) care is critical in high-burden nations.
• Patients in rural areas often start, but do not finish, the multi-day TB evaluation process.

Purpose of the Study:

• To investigate the association between geographic barriers (distance and travel time) and the completion of TB evaluation among adults with chronic cough in rural Uganda.

Main Methods:

• A cross-sectional study analyzed data from 264,511 patient encounters across six rural Ugandan primary health clinics (2009-2012).
• Geographic Information Systems (GIS) were used to calculate travel time from home parish to health centers, considering roads, land cover, and slope.
• The association between measured distance, travel time, and TB evaluation completion was assessed.

Main Results:

• Out of 4,640 adults with ordered sputum smear microscopy, 2,783 (60%) completed TB evaluation.
• Median travel time was slightly higher for patients with TB examination ordered (68 minutes) compared to those without (60 minutes; P < 0.010).
• Neither home-to-clinic distance nor calculated travel time significantly predicted TB evaluation completion across most clinics.

Conclusions:

• Geographic barriers, as measured by distance and travel time, did not emerge as significant predictors for completing TB evaluation in this rural Ugandan setting.
• Limitations in available mapping data hindered the full application of GIS techniques.
• Improved data on geographic access to TB services is essential for enhancing TB diagnosis and care in similar settings.