Factors affecting patient presentation at a national dermatology referral clinic in Kampala, Uganda.
BACKGROUND
This study sought to gain a better understanding of the patient population in Kampala and was further designed to elucidate barriers that may delay individuals from receiving proper dermatologic care.


METHODS
The study took place at the dermatovenereology clinic of a tertiary care hospital in Kampala. New adult patients were surveyed in July and August of 2013. The primary dependent variable was time from reported onset of symptoms to presentation to the clinic. Participant demographic characteristics, medical and treatment history, and perception of illness as measured by the dermatology life quality index (DLQI) were assessed.


RESULTS
A total of 232 subjects participated in the study. The most common skin diseases were allergic (20.3%), infectious (15.1%), follicular (7.8%), and papulosquamous (7.8%) disorders. Greater home distance from the clinic correlated with later presentation times (r = 0.259, P < 0.001). DLQI score was not correlated with presentation time. HIV+ individuals presented earlier (mean 5 vs. 11 months, P = 0.043) and had higher DLQI scores (mean 12.6 vs. 9.3, P = 0.006) than HIV- individuals. The majority of participants (72.5%) had contact with at least one other healthcare worker (HCW) for management of their dermatologic symptoms; 65.8% reported that these previous treatments were ineffective.


CONCLUSIONS
Efforts to educate HCWs should be focused on districts outside of Kampala and highlight recognition and proper treatment of allergic diseases. HCWs should aggressively treat skin problems in HIV+ individuals. HCWs practicing in Kampala without formal dermatological training should refer patients with skin disease to the clinic, as patients may receive care that is more appropriate.
University of Connecticut School of Medicine, Farmington, CT, USA.
Eunice S
ES
Song
National Referral Skin and STD Unit of Mulago Hospital, Kampala, Uganda.
Patrick
P
Musinguzi
University of Connecticut School of Medicine, Farmington, CT, USA.
Kevin D
KD
Dieckhaus
D000293:Adolescent; D000328:Adult; D000368:Aged; D003880:Dermatology; D005260:Female; D006679:HIV Seropositivity / Q000150:complications; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D012017:Referral and Consultation; D012649:Self Concept; D012871:Skin Diseases / Q000150:complications / Q000628:therapy*; D012923:Social Class; D011795:Surveys and Questionnaires; D013997:Time Factors; D014454:Uganda; D055815:Young Adult