Healthcare-seeking behaviour, barriers to care and predictors of symptom improvement among patients with cardiovascular disease in northern Tanzania.
Abstract
<h4>Background</h4>Little is known about healthcare-seeking behaviour and barriers
to care for cardiovascular disease (CVD) in sub-Saharan Africa.<h4>Methods</h4>Emergency
department patients in Tanzania with acute CVD were prospectively enrolled. Questionnaires
were administered at enrollment and 30 d later.<h4>Results</h4>Of 241 patients, 186
(77.2%) had visited another facility for the same illness episode (median symptom
duration prior to presentation was 7 d) and 82 (34.0%) reported that they were initially
unaware of the potential seriousness of their symptoms. Of the 208 (86.3%) patients
completing follow-up, 16 (7.7%) had died, 38 (18.3%) had visited another facility
for persistent symptoms, 99 (47.6%) felt they understood their diagnosis, 87 (41.8%)
felt they understood their treatment and 11 (7.8%) could identify any of their medications.
Predictors of 30 d survival with symptom improvement included medication compliance
(p<0.001), understanding the diagnosis (p=0.007), understanding the treatment (p<0.001)
and greater CVD knowledge (p=0.008).<h4>Conclusions</h4>Patients with CVD in Tanzania
usually visit multiple facilities for the same illness episode, typically after prolonged
delays. Only a minority understand their diagnosis and treatment, and such understanding
is correlated with survival with symptom improvement. Patient-centred interventions
are needed to improve the quality of cardiovascular care in Tanzania.
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https://hdl.handle.net/10161/25536Published Version (Please cite this version)
10.1093/inthealth/ihz095Publication Info
Hertz, Julian T; Sakita, Francis M; Kweka, Godfrey L; Loring, Zak; Thielman, Nathan
M; Temu, Gloria; & Bartlett, John A (2019). Healthcare-seeking behaviour, barriers to care and predictors of symptom improvement
among patients with cardiovascular disease in northern Tanzania. International health, 14(4). pp. ihz095. 10.1093/inthealth/ihz095. Retrieved from https://hdl.handle.net/10161/25536.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Alexander Bartlett
Professor of Medicine
My clinical investigation is focused on the pathogenesis and treatment of HIV infection
and its complications, especially in resource-limited settings. Key Words: HIV infection,
AIDS, treatment strategies, treatment failure, co-infections, resource-limited settings
Julian T Hertz
Associate Professor of Emergency Medicine
Julian Hertz, MD, MSc, is an Associate Professor of Emergency Medicine & Global Health.
He graduated summa cum laude from Princeton University and attended medical school
at Duke University, where he received the Dean's Merit Scholarship and the Thomas
Jefferson Award for leadership. He completed his residency training in emergency medicine
at Vanderbilt University Medical Center and his fellowship in Global Health at Duke.Dr.
Hertz's primary interests include globa
Zak Loring
Assistant Professor of Medicine
I am a cardiac electrophysiologist specializing in the treatment of heart rhythm disorders
and management of cardiac implantable electronic devices (CIEDs). My research utilizes
signal processing of electrocardiographic data and novel analytic techniques to better
phenotype patients and identify those for whom interventional electrophysiology procedures
may be most beneficial. This includes predicting which patients with left bundle branch
block may benefit from early cardiac resynchronizatio
Nathan Maclyn Thielman
Professor of Medicine
Broadly, my research focuses on a range of clinical and social issues that affect
persons living with or at risk for HIV infection in resource-poor settings. In Tanzania,
our group is applying novel methods to optimize HIV testing uptake among high-risk
groups. We recently demonstrated that the Discrete Choice Experiment (DCE), a form
of stated preference survey research, is a robust tool for identifying (a) which characteristics
of HIV testing options are most preferred by different populati
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