title: [Management of tuberculosis patients in the urban setting: health service delivery and health care-seeking behavior].
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: André
authors.initials: A
authors.lastname: Nana Yakam
authors.forename: Juergen
authors.initials: J
authors.lastname: Noeske
authors.forename: Carrine
authors.initials: C
authors.lastname: Angumua
authors.forename: Samuel
authors.initials: S
authors.lastname: Bowong
authors.forename: Louis
authors.initials: L
authors.lastname: Aimé Fono
mesh_terms: D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*; D019037:Urban Health Services; D014505:Urban Population; D055815:Young Adult