ArticlePloS one2020
Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- "It was difficult to offer same day results": evaluation of community-based point-of-care testing for sexually transmitted infections among youth using the GeneXpert platform in Zimbabwe.BMC health services research · 2022Trial
- Diagnostic Performance of the Pluslife MiniDock MTB and Molbio MTB Ultima Assays to Detect Tuberculosis From Tongue and Sputum Swabs Among Outpatients and in Active Case Finding in Cameroon.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Article
- Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review.BMC infectious diseases · 2022Article
- Barriers to tuberculosis case finding in primary and secondary health facilities in Ghana: perceptions, experiences and practices of healthcare workers.BMC health services research · 2022Article
- Missed Tuberculosis Investigations and Associated Factors in Patients with Symptoms Indicative of Tuberculosis at Public Health Institutions in Northwest Ethiopia: The Application of a Negative Binomial Model.Infection and drug resistance · 2022Article
- Is aggregated surveillance data a reliable method for constructing tuberculosis care cascades? A secondary data analysis from Uganda.PLOS global public health · 2022Article
- Surveying and mapping breast cancer services in Ghana: a cross-sectional pilot study in the Eastern Region.BMJ open · 2021Article
- Geospatial analysis and impact of targeted development of breast cancer care in The Gambia: a cross-sectional study.BMC health services research · 2021Article
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Authors and funding
5 authors.
Funding
Abstract
backgroundGhana's national prevalence survey showed higher than expected tuberculosis (TB) prevalence, indicating that many people with TB are not identified and treated. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment.
methodsA prospective cohort study was conducted in urban and rural health facilities in south-east Ghana. Consecutive patients routinely identified as needing a TB test were followed up for two months to find out if sputum was submitted and/or treatment started. The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression.
resultsA total of 428 persons (mean age 48 years, 67.3% female) were recruited, 285 (66.6%) from urban and 143 (33.4%) from rural facilities. Of 410 (96%) individuals followed up, 290 (70.7%) submitted sputum, among which 27 (14.1%) had a positive result and started treatment. Among those who visited an urban facility, 245/267(91.8%) submitted sputum, compared to 45/143 (31.5%) who visited a rural facility. Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84-42.51). After adjustment for confounding, there was still a strong association between attending the urban facility and submitting sputum (adjusted OR (aOR) 9.52, 95%CI 3.87-23.40). Travel distance of >10 km to the laboratory was the strongest predictor of not submitting sputum (aOR 0.12, 95%CI 0.05-0.33).
conclusionThe majority of presumptive TB patients attending a rural health facility did not submit sputum for testing, mainly due to the long travel distance to the laboratory. Bridging this gap in the diagnostic cascade may improve case detection.
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