Factors associated with low tuberculosis case detection and investigation in public health facilities (PHFs) in Uganda: A case study of Bududa district

Abstract Background Although great strides have been made to control and cure tuberculosis (TB) globally, Uganda has a high burden with an annual incidence of 200/100,000 persons and a mortality rate of 35 per 100,000 persons. The extent to which patients with symptoms indicative of TB access care and receive TB testing at public health facilities (PHFs) in Bududa districts, eastern Uganda, and the factors associated with it are unknown. This study aimed to determine the proportion of patients with symptoms that might suggest TB and received care and TB testing at the PHFs in Bududa districts and to explore the factors that were associated with this proportion. Methods A cross-sectional study that employed both quantitative and qualitative data collection techniques was conducted in November 2019 on consenting respondents with symptoms that might suggest TB who sought care in PHFs in Bududa districts and key informants overseeing TB care in the district. Findings: A response rate of 97.6% (249/255) was recorded. Only 18.8% (46/256) of respondents who reported having symptoms suggestive of tuberculosis were investigated for TB. The majority of patients, 87.4% (214/245), never had sputum requested, and up to 91.7% (222/242) never had a chest X-ray (CXR) done. Participants who came through the outpatient department (OPD) were 12% less likely to be screened or investigated for TB than those coming through the ART clinic (PR = 0.88, 95% CI (0.79, 0.98). Patients who came from rural areas were 26% more likely to miss TB screening or investigation compared to those patients from urban areas (PR = 1.26, 95%CI (1.16, 1.38). Factors contributing to low TB detection rates were too much workload, lack of technical staff to carry out TB investigation and diagnosis, inadequate supplies and TB medicines, lack of equipment and unreliable electricity. Conclusion This study highlights the need for increased TB screening and investigation in PHFs in Bududa district, particularly in rural areas. To improve TB detection, investigation and diagnosis, the healthcare system invests in more technical staff, equipment, protective gear, and TB drugs. Additionally, the healthcare system should ensure that there is adequate reliable electricity to avoid equipment breakdowns.