Factors associated with access to tuberculosis care among tuberculosis patients in Mandera East Sub-County, Kenya

Abstract

Background: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. In 2021, 10.6 million individuals got infected with tuberculosis globally and tuberculosis incidence in Kenya was 251 cases per 100,000 population. Between 2019–2021, Mandera county had 1223 cases of which 68 (6%) were lost to follow up and 55 died giving a case fatality rate of 4.5%. The lost to follow-up and mortality could be attributed to a lack of access to tuberculosis care that may also result in drug-resistant tuberculosis. Access to tuberculosis care is the timely use of all the healthcare services provided at the tuberculosis clinic for patients to achieve the desired outcome which is to complete treatment. Objectives: to determine patient related and health-facility-related factors associated with access to tuberculosis care among tuberculosis patients in Mandera east sub-county. Method: a cross-sectional study was used. The target population were individuals aged 18 years and above who were diagnosed with tuberculosis in Mandera county. Using a sampling frame of 1223 from TIBU system, a total of 394 tuberculosis patients were selected using simple random sampling. Structured questionnaires were used to collect data from the selected patients on health facility and patient related variables. Descriptive analysis was done by calculating frequencies and proportions for categorical variables. Inferential analysis was conducted using adjusted prevalence odds ratio (aPOR). Results: most respondents were male at 64.5% (231/358), and urban residents were 83.2% (298/358). Those who had means of transport to the facility were 83.2% (298/358) while those with fare were 20.9% (75/358). Those who did not experience adverse drug reactions were 79.9% (286/358). A majority, 70.4% (252/358) had a tuberculosis clinic in their town of residence, while 77.7% (278/358) were able to access the tuberculosis clinic because they lived within 5 kilometers radius to a clinic. Access to tuberculosis care was 88.8%. Those with means of transport had higher odds of access to tuberculosis care in comparison to those who lacked (aPOR=19.53, p<0.001). Respondents with fare had higher odds of accessing tuberculosis care in comparison to the ones without fare (aPOR=20.33, p<0.001). Those who adhered to medications had 48.34 times odds of accessing tuberculosis care in comparison to the ones who did not adhere (aPOR=48.34, p<0.001). The odds of accessing tuberculosis care were higher in those who had tuberculosis clinic in their town of residence compared to the ones who did not have (aPOR=5.26, p=0.008). Those who had privacy at the health facility had higher odds of accessing tuberculosis care (aPOR=12.92, p<0.001) in comparison to the ones who did not. Conclusion: several factors associated with access to tuberculosis care among patients in Mandera East sub-county. Access to transportation, affordability of fare, medication adherence, availability of a tuberculosis clinic in the patient's town of residence, and privacy at the health facility were significant predictors of access to care. Recommendations: To improve access to tuberculosis care in Mandera East sub-county; stakeholders can work towards improving access to transport services, community engagement, financial and medication adherence support.