Patterns and patient factors associated with loss to follow-up in the Muhimbili sickle cell cohort, Tanzania

Autor: Jesca Ondengo, Siana Nkya, Daniel Kandonga, Upendo Masamu, Julie Makani, Bruno Mmbando, Flora Ndobho, Raphael Z. Sangeda, Khadija Msami
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: BMC Health Services Research, Vol 20, Iss 1, Pp 1-10 (2020)
BMC Health Services Research
ISSN: 1472-6963
Popis: Background Monitoring patient’s clinical attendance is a crucial means of improving retention in care and treatment programmes. Sickle cell patients’ outcomes are improved by participation in comprehensive care programmes, but these benefits cannot be achieved when patients are lost from clinical care. In this study, patients are defined as loss to follow-up when they did not attend clinic for more than 9 months. Precise information on the retention rate and characteristics of those who are not following their clinic appointments is needed to enable the implementation of interventions that will be effective in increasing the retention to care. Method This was a retrospective study involving sickle cell patients registered in the Muhimbili Sickle Cohort in Tanzania. Descriptive and survival analysis techniques both non-parametric methods (Kaplan-Meier estimator and Log-rank test) and semi-parametric method (Cox’s proportional hazard model), were used. A p-value of 0.05 was considered significant to make an inference from the analysis. Results A total of 5476 patients were registered in the cohort from 2004 to 2016. Of these, 3350 (58.13%) were actively participating in clinics, while 2126 (41.87%) were inactive, of which 1927 (35.19%) were loss to follow-up. We used data from 2004 to 2014 because between 2015 and 2016, patients were referred to other government hospitals. From the survival analysis results, pediatric (HR: 14.29,95% CI: 11.0071–18.5768, p p p = 0.0039) or mean cell volume (HR: 4.28, (95% CI: 1.0260–1.0598, p Conclusion Loss to follow-up is evident in the cohort of patients in long term comprehensive care. It is, therefore, necessary to design interventions that improve patients’ retention. Suggested solutions include refresher training for health care workers and those responsible for patient follow-up on techniques for retaining patients and comprehensive transition programs to prepare patients who are moving from pediatric to adult clinics.
Databáze: OpenAIRE
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