Using Patient Pathway analysis in Rwanda: Methods, problems and the importance of data and sensitivity analysis

E-poster presented during the Union World Conference 2020.

Puck Pelzer, Sarah van de Berg, Augustin Dushime, Patrick Migambi, Max Meis, KNCV Tuberculosis Foundation.


  • TB ranks third in causes of death in Rwanda
  • Late diagnosis and treatment may contribute to mortality
  • There is limited information on access to care for persons with TB symptoms in Rwanda
  • We aimed to assess alignment of health care seeking behavior and TB service availability


  • A national level PPA was completed using 2014/15 DHS data and Master Facility List from the National Ministry of Health
  • The primary measures were place of initial care seeking, TB diagnostic- and treatment locations
  • We conducted sensitivity analyses using different definitions for the primary measures


  • Most persons with TB symptoms sought care at the public level 1 facilities
  • All public level 1 facilities had diagnostic capacity – or sample transportation and can provide first-line treatment
  • Second-line treatment was available at two district hospitals
  • 81% of persons with TB symptoms had access to TB diagnostic or treatment services at their “first” visit
  • Sensitivity analysis showed that access to care is lower (52%) if care seeking data of children is used as proxy for TB care seeking


  • Care seeking and service availability are well aligned in Rwanda
  • Divergent results can be obtained from the use of different parameters and definitions
  • Sensitivity analyses should be conducted as part of PPA to determine optimal definitions of the PPA measures

KNCV has been fighting TB since its establishment in 1903. Over the past 120 years, the organization has acquired indispensable knowledge and experience in the field of effective TB prevention and care, resulting in pre-elimination in the Netherlands and significant contributions to global evidence generation, policy development and TB program implementation worldwide.

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