Pathways and costs of care for patients with tuberculosis symptoms in rural Uganda.
Pathways and costs of care for patients with tuberculosis symptoms in rural Uganda.
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DOI：
10.5588/ijtld.14.0166
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发表时间：
2015-08
期刊：
影响因子：
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通讯作者：
Cattamanchi A
中科院分区：
文献类型：
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作者：
Shete PB;Haguma P;Miller CR;Ochom E;Ayakaka I;Davis JL;Dowdy DW;Hopewell P;Katamba A;Cattamanchi A
乌干达农村和周边社区的六个区级政府卫生中心。确定乌干达转诊接受结核病（TB）评估的慢性咳嗽患者的护理途径和相关费用。我们进行了一项横断面研究，调查了64名慢性咳嗽患者，并在政府诊所进行了首次痰液评估。我们还随机调查了周围社区的114名慢性咳嗽患者。我们收集了以前的咳嗽健康检查信息以及与当前检查相关的费用。80%的门诊患者以前曾因咳嗽寻求治疗，中位数为3次既往就诊（范围0-32，四分位数间距[IQR] 2-5）。大多数（n = 203，88%）访问的卫生设施，不提供结核病显微镜检查服务，大多数发生在私营部门。仅本次就诊的医疗费用就占患者家庭月收入中位数的28.8%（IQR 9.1-109.5）。大多数慢性咳嗽患者寻求医疗保健，但首先在私营部门这样做。私营部门的参与和简化结核病诊断评价对于改善病例发现和实现全球消除结核病目标至关重要。
Six district-level government health centers in rural Uganda and the surrounding communities. To determine pathways to care and associated costs for patients with chronic cough referred for tuberculosis (TB) evaluation in Uganda. We conducted a cross-sectional study, surveying 64 patients presenting with chronic cough and undergoing first-time sputum evaluation at government clinics. We also surveyed a random sample of 114 individuals with chronic cough in surrounding communities. We collected information on previous health visits for the cough as well as costs associated with the current visit. Eighty per cent of clinic patients had previously sought care for their cough, with a median of three previous visits (range 0–32, interquartile range [IQR] 2–5). Most (n = 203, 88%) visits were to a health facility that did not provide TB microscopy services, and the majority occurred in the private sector. The cost of seeking care for the current visit alone represented 28.8% (IQR 9.1–109.5) of the patients’ median monthly household income. Most patients seek health care for chronic cough, but do so first in the private sector. Engagement of the private sector and streamlining TB diagnostic evaluation are critical for improving case detection and meeting global TB elimination targets.