Management of tuberculosis patients in the urban setting: health service delivery and health care-seeking behaviour

Objectives: This descriptive and prospective study was designed to determine the incidence of smear-positive pulmonary tuberculosis (PTB+) by health area (HA) in Douala, use of Diagnosis and Treatment Centres (DTCs) and the factors influencing the choice of DTC. Methods: Over a one-year period, the residence of all PTB+ patients and the DTC at which they were treated were located by means of a GPS system and represented on a geo-referenced health map. Incidence of PTB+ per HA was calculated. Focus group discussions with TB patients were then held in seven of the nineteen DTCs chosen by convenience. Results: The incidence of PTB+ is not randomly distributed between HAs, as the incidence is fivefold higher than the mean in some HAs. More than one half of patients (65%) were not treated in the DTC to which they were designated by the health system. Attendance in a DTC mostly depends on chance decisions based on previous experiences with a health care unit, recommendations from family members, friends or strangers, or the (sometimes erroneous) reference by health care personnel. References rarely follow the logic of the system. Conclusion: The provision of health care for TB in the city of Douala and health care-seeking behaviour of patients frequently do not correspond. Information and communication on TB care delivery could make the management of tuberculosis more efficient and more effective.