Paper long abstract:

Background: In 2017, there were an estimated 10.4 million new tuberculosis (TB) cases worldwide and 1.4 million TB deaths. Tuberculosis is a public health problem in Cameroon, especially in Douala, the economic capital and the first TB epidemiology's region, which counts for 11% of total population, but register almost 20% of the TB prevalence in Cameroon. In Cameroon, tuberculosis cases are diagnosed and treated within a nationwide network of 248 diagnostic and treatment centres (DTC).The DTC are suppose geographically distributed according to World health organization (WHO) recommendations, planning to bring DTC (offer) closer to patients (demand). The objective of this study was to analyse the spatial distribution of TB cases, in relation with the DTC and to identify the socio-economic factors linking the "demand" to the "offer".

Methods: The studied population includes confirmed TB patients, permanently resident (≥ 3 months) in Douala, between May, 1st 2011 and April, 30th 2012. During one year, a cohort of 2132 adults patients consecutively diagnosed with TB in any one of the twenty one (21) DTCs, who consented to participate to the study were interviewed; their residence and DTC were mapped using Geographic information system, by going to their home (In Douala, as others African cities, houses and streets are not addressed). The membership of each patient to a DTC (closest to his residence) was established. The "observed" number of patients attending the DTCs during the study period was compared to the "expected" number, using a bivariate analysis. Multivariate analysis using logistic regression and the analysis of variance were used to determine factors associated to the "demand" and "offer" of DTCs respectively.

Results: It emerges that, even if TB patients are concentrated around the DTCs, the majority of them (65%) goes far from their designated DTC, to seek for treatment. The decentralization policy advocated by the national tuberculosis program (NTP) is not always followed by the patients. Thus, the "expected" and the "observed" number of patients in DTCs were not correlated. Patients seeking treatment closer to their residence were mainly women and patients from large size household. Attendance of DTC was associated with their category and the quality of service.

Conclusion: Generally, the health system emphasizes its policy in bringing health facilities (HF) closer to population. In large cities, where several HF "compete", this criterion should be extended to the category of HF and the socio-economic characteristics of the target population.