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IMPACT OF GEOGRAPHIC DISTANCE ON TB CONTROL IN KAMPALA, UGANDA

Chiunda, Allan Brian
http://rave.ohiolink.edu/etdc/view?acc_num=case1330718541

Abstract Details

2012, Doctor of Philosophy, Case Western Reserve University, Epidemiology and Biostatistics.
Background: A more sophisticated and conceptually realistic measure of geographic distance using network time may provide a better measure of geographic access to TB control health services compared to the traditional Euclidean ‘as-the-crow-flies’ distance. Objectives: 1) Compare Network time to Euclidean distance; 2) Determine the association between Network time and Euclidean distance to LTBI treatment adherence; 3) Determine the association between network time and Euclidean distance to treatment seeking delay. Design: The data for this study was from a longitudinal cohort Tuberculosis (TB) study called the Kawempe Community Health Study. Setting: The study was based in Kampala, Uganda. The data for manuscript 1 was collected from April 1, 2002 to December 31, 2009 while the data available for manuscripts 2 and 3 was collected during the period April 1, 2002 to December 31, 2007. Patients: Manuscript 1 included geographic coordinates of N=663 patient homes; Manuscript 2 included N=361 study participants who were receiving LTBI treatment; Manuscript 3 included N=325 symptomatic active TB cases who presented to the national TB clinic for treatment. Analysis: Means/Standard Deviation and Median and inter-quartile range were used to summarize the data where parametric and non-parametric respectively. Spearman’s correlation and Linear Regression is used to evaluate the relationship and the statistical fit between Euclidean distance and Network travel time. Bivariate analyses using Chi-square and the student t and Wilcoxon’s test were performed and significant variables (at p < 0.2) included in the multivariable logistic model using PROC GENMOD. All the analyses were done in Statistic Analysis Software (SAS Institute version 9.2, Inc., Cary, North Carolina). Results: The two measures of geographic distance were correlated but that Network time offered better statistical fit. 2) Greater geographic time was associated with poor adherence. Furthermore network time was a better predictor of adherence than Euclidean distance. 3) Greater geographic time was associated with TB treatment seeking delay. Discussion: The availability of robust GIS applications have allowed a more sophisticated and realistic measure of geographic access using Network time compared to Euclidean distance. A better measure of geographic distance may be used for more effective health service resource allocation and improve access. Furthermore, the results may allow more effective targeting of TB control interventions to individuals with poor geographic access that may be more likely to be non-adherent to treatment as well as delay seeking TB treatment.
Duncan Neuhauser (Committee Chair)
Charles King (Committee Member)
Sara Debanne (Committee Member)
119 p.
Epidemiology
Geographic distance; Access; HSR; TB

Recommended Citations

Citations

  • Chiunda, A. B. (2012). IMPACT OF GEOGRAPHIC DISTANCE ON TB CONTROL IN KAMPALA, UGANDA [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1330718541

    APA Style (7th edition)

  • Chiunda, Allan. IMPACT OF GEOGRAPHIC DISTANCE ON TB CONTROL IN KAMPALA, UGANDA. 2012. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1330718541.

    MLA Style (8th edition)

  • Chiunda, Allan. "IMPACT OF GEOGRAPHIC DISTANCE ON TB CONTROL IN KAMPALA, UGANDA." Doctoral dissertation, Case Western Reserve University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=case1330718541

    Chicago Manual of Style (17th edition)

case1330718541
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© 2012, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.