Delays in diagnosis and treatment of pulmonary tuberculosis in patients seeking care at a regional referral hospital, Uganda: a cross sectional study (original) (raw)
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Pan African Medical Journal, 2013
Introduction: Delay in the diagnosis of pulmonary tuberculosis (PTB) is common in many countries in Sub-Saharan Africa. Timely diagnosis of active tuberculosis is crucial in minimizing morbidity and mortality in the community as well as nosocomial transmission in health care facilities. This study aimed at determining factors associated with health service delay in the diagnosis and initiation of treatment among new PTB patients presenting to the National Referral Hospital-Mulago. Methods: This was a cross-sectional study among eligible new PTB patients presenting at the National referral TB treatment center Mulago hospital, between March to May 2009. The patients were consecutively recruited and interviewed using a semi-structured questionnaire to assess socio-demographic and health service factors. Multivariate logistic regression using odds ratios and 95% confidence intervals was done. Results: Two hundred and sixty six newly diagnosed PTB patients were enrolled, of which 65.4% experienced health systems delay. The median health service delay was 9days (IQR=8-19). Factors associated with health service delay were: 1npatient (OR= 4.68, 95% CI: 1.91-11.45), secondary as highest level of education attained (OR= 3.56, 95% CI: 1.18-10.74), primary as highest level of education attained (OR= 6.70, 95% CI: 2.13-21.02), presence of fever (OR= 3.28, 95% CI: 1.05-10.79), and patient delay at health facility (OR= 5.01, 95% CI: 1.33-18.9). Conclusion: The study found a significant proportion of Health service delay among pulmonary tuberculosis patients presenting at the referral hospital. Being an in-patient and having fever as a symptom of tuberculosis needs further attention in order to have timely diagnosis. There is need for awareness on TB especially that most of the TB symptoms present like other febrile illnesses such as malaria and needs consideration when patients present to a health facility.
BMC Infectious Diseases, 2016
Background: Tuberculosis (TB) is a major public health concern in the developing world. Early diagnosis and prompt initiation of treatment is essential for effective TB control. The aim of this study was to determine the length and analyze associated factors of patients' and health system's delays in the diagnosis and treatment of new pulmonary TB (PTB) patients. Methods: A cross-sectional study was conducted in 30 randomly selected public health facilities in West Gojjam Zone, Amhara Region, Ethiopia. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study. Patients' delay (the time period from onset of TB symptoms to first presentation to a formal health provider) and health system's delay (the time period from first presentation to a formal health provider to first start of TB treatment) were measured. Median patients' and health system's delays were calculated. Mixed effect logistic regression was used to analyze predictors of patients' and health system's delays. Results: Seven hundred six patients were enrolled in the study. The median patients' delay was 18 days (interquartile range [IQR]: 8-34 days) and the median health system's delay was 22 days (IQR: 4-88 days). Poor knowledge of TB (adjusted odds ratio [AOR], 2.33; 95 % confidence interval [CI], 1.34-4.05), first visit to non-formal health provider (AOR, 47.56; 95 % CI, 26.31-85.99), self-treatment (AOR, 10.11; 95 % CI, 4.53-22.56) and patients' age (≥45 years) (AOR, 2.99; 95 % CI, 1.14-7.81) were independent predictors of patients' delay. Smear-negative TB (AOR, 1.88; 95 % CI, 1.32-2.68) and first visit to public health centers (AOR, 2.22; 95 % CI, 1.52-3.25) and health posts (AOR, 5.86; 95 % CI, 1.40-24.39) were found to be independent predictors of health system's delay. Conclusions: The health system's delay in this study was long and contributed more than 50 % of the total delay. Better TB diagnostic tools to complement sputum smear microscopy are needed to early diagnose PTB cases at peripheral health facilities. In addition, due emphasis should be given to increase public awareness about symptoms and consequences of TB disease.
European Journal of Clinical and Biomedical Sciences
Early diagnosis and immediate initiation of treatment are essential for an effective TB control program. Delay in treatment is significant to both disease prognoses at the individual level and within the community. Patient delay and associated factors were assessed among pulmonary tuberculosis patients who are on treatment for the first two months at Hadiya zone public health facilities, south Ethiopia, 2017. Facility based cross sectional study triangulated by Qualitative study was employed on 340 Pulmonary Tuberculosis patients from March 10-April 20, 2017. Simple random sampling technique was used to select study health facility. Directly Observed Treatment Short-course User at the beginning of data collection was consecutively recruited in to the study until the intended 340 sample sizes were fulfilled. Data was collected from the participants using a pretested structured interviewer administered questionnaire. Multivariable binary Logistic regressions were used to identify independent predictors of Tuberculosis treatment delay for those variables which are candidate in bivariate analysis. A P-value < 0.05 at 95 % confidence intervals was considered statistical significance between dependent and predictors variables. Three hundred and Forty PTB patients with a response rate of 97.7% were enrolled from seven diagnostics and treatment centers. Among 340 Pulmonary Tuberculosis patients enrolled in the study, of which 49.1% experienced patient delay. The median patient delay was 31. Unable to read and write (AOR 6, 95% CI (3.11 21.36), Poor knowledge of Tuberculosis (AOR 3.96, 95% CI (2.286.86), self-treatment (AOR: 2, 95% CI (1.143.93), and financial constraint (AOR: 2.092, 95% CI (1.113.945) were the independent predictors of patient delay. Nearly half of the patients seek their first consultation after thirty days cutoff point. Unable to read and write, Poor knowledge of Tuberculosis, self-treatment and financial constraints were found to have association with patient delay. This may lead to continues existence of Tuberculosis cases which probably leads to the emergence of multiple drugs resistant. Implementation of well-designed information education, communication/behavioral change communication strategy for Tuberculosis control program to overcome high prevalence of patient delay.
factors associated with delay in TB treatment
Background. Unknown proportions of tuberculosis cases remain undiagnosed and untreated as result of several factors which further increases the number of tuberculosis cases per index case. Objective. To identify factors associated with patient's delay in initiating treatment of tuberculosis. Methods. Cross-sectional study was employed from January to April, 2013, in Bahir Dar Ethiopia. A total of 360 patients were included. Data were collected from tuberculosis patients using a semistructured questionnaire. Data were entered and analyzed using SPSS version 16 windows. Multivariate logistic regression analysis was used to identify factors associated with patient delay. Results. Of all patients, 211 (62%) sought medical care after the WHO recommended period (21 days). The median patient delays of smear positive, smear negative, and extrapulmonary patients were 27 (IQR: 10-59), 30 (IQR: 9-65), and 31 (IQR: 10-150) days, respectively, with statistically significant variations among them (ANOVA: = 5.96; < 0.003). Place of residence and educational status were the predictors of patient delay. Conclusion. Around two-thirds of all patients and more than half of smear positive tuberculosis patients were delayed in seeking medical care within the recommended period. Provision of DOTS service in the vicinity and health education on TB may reduce patient delay and its consequences.
Tuberculosis diagnostic and treatment delays among patients in Uganda
Health Science Reports, 2023
Background: Mycobacterium tuberculosis, a bacterium that relies on its human host to achieve airborne transmission and existence, is the primary cause of tuberculosis (TB), a disease that is vital to public health. Aim: To update the society on tuberculosis diagnostic and treatment delays among patients in Uganda. Materials and Methods: The review paper utilized different search engines, such as Pubmed Central, Scopus, Web of Science, Google Scholar, and so forth, to conduct this review paper. Results: Delays in diagnosis could cause diseases to spread throughout the community, progress more quickly, and increase mortality. With many populations experiencing TB diagnostic delay and less than a third of the population experiencing TB treatment delay, the rates of tuberculosis diagnosis and treatment delays are high. Conclusion: The delay in diagnosing and treating tuberculosis in men is positively correlated with knowledge of the disease's symptoms and the regular use of a handkerchief or both hands to cover the mouth and nose while coughing or sneezing.
Factors associated with DELAY in diagnosis among tuberculosis patients in Hohoe Municipality, Ghana
BMC Public Health, 2015
Background: Any delay in diagnosis and consequently treatment of TB patients not only increases the infectivity of the disease in the community, but may also lead to more advance disease state, which may result in more complications and expose patients to higher risk of death. The aim of this study was to assess delays in diagnosing new TB patients and the factors associated with these delays in Hohoe Municipality of Ghana. Methods: A cross sectional study was carried out among 73 new TB Patients, 15 years or older, registered between 1st June, 2013 and 31st May, 2014 in Hohoe Municipality. Questionnaires were administered to patients to evaluate factors related to delay by patients in seeking care, delays at healthcare facilities, and total diagnostic delay. Logistic regression was used to determine the factors associated with patient delay (>30 days), healthcare services delay (>15 days), and total delay (>45 days). Results: The median total delay was 104 days (inter-quartile range (IQR):17-191). The median patient delay was 59 days (IQR: 5-123), and the median healthcare services delay was 45 days (IQR: 38-128). Not medically insured (AOR = 6.12; 95 % CI: 1.26-29.88; P < 0.025) and perceived stigma (AOR = 5.30; 95 % CI: 1.33-21.18; P < 0.018) were risk factors associated with prolonged patient delay. Multiple healthcare contact following signs and symptoms (AOR = 10.26; 95 %CI: 2.95-35.72; P < 0.0001) was the only risk factor associated with prolonged healthcare services delay. Conclusion: There is a considerable delay in TB case detection mainly due to patients delay in seeking healthcare. The factors associated with patients' delay include lack of medical insurance, perceived stigma, and making multiple healthcare encounters. Health system strengthening towards decentralizing TB diagnosis and management, raising public awareness about the disease, training of healthcare providers, and collaborating with non-formal healthcare providers may reduce long delays in the management of TB.
BMC Public Health, 2012
Background: TB is a major public health problem globally and Ethiopia is 8 th among the 22 high burden countries. Early detection and effective treatment are prerequisites for a successful TB control programme. In this regard, early health seeking action from patients' side and prompt diagnosis as well as initiation of treatment from the health system's side are essential steps. The aim of this study was to assess delay in the diagnosis and treatment of TB in a predominantly pastoralist area in Ethiopia. Methods: On a cross-sectional study, two hundred sixteen TB patients who visited DOTS clinics of two health facilities in Afar Region were included consecutively. Time from onset of symptoms till first consultation of formal health providers (patients' delay) and time from first consultation till initiation of treatment (health system's delay) were analyzed. Results: The median patients' and health system's delay were 20 and 33.5 days, respectively. The median total delay was 70.5 days with a median treatment delay of 1 day. On multivariate logistic regression, self-treatment (aOR. 3.99, CI 1.50-10.59) and first visit to non-formal health providers (aOR. 6.18, CI 1.84-20.76) were observed to be independent predictors of patients' delay. On the other hand, having extra-pulmonary TB (aOR. 2.08, CI 1.08-4.04), and a first visit to health posts/clinics (aOR. 19.70, CI 6.18-62.79), health centres (aOR. 4.83, CI 2.23-10.43) and private health facilities (aOR. 2.49, CI 1.07-5.84) were found to be independent predictors of health system's delay. Conclusions: There is a long delay in the diagnosis and initiation of treatment and this was mainly attributable to the health system. Health system strengthening towards improved diagnosis of TB could reduce the long health system's delay in the management of TB in the study area.
East African Medical Journal, 2008
Objective: to determine the length of delays from onset of symptoms to initiation of treatment of pulmonary tuberculosis (ptb). Design: Cross-sectional study. Setting: Chest/tb clinic, moi teaching and referral hospital (mtrh), eldoret, Kenya. Subjects: newly diagnosed smear positive pulmonary tuberculosis (ptb) patients. Results: two hundred and thirty patients aged between 12 and 80 (median; 28.5) years were included in the study. they comprised 148 (64.3%, median 30 years) males and 82 (35.7%, median 28 years) females. one hundred and two (44%) came from urban and 128 (56%) came from rural setting covering a median distance of 10 (range 0-100) kilometres and paying Kshs 20 (range 0-200) to facility. Cough was the commonest symptom reported by 228 (99.1%) of the patients followed by chest pain in 214 (80%). the mean patient delay was 11 ± 17 weeks (range: 1-78 weeks) with no significant difference between males and females, the mean system delay was 3 ± 5 weeks (range: 0-39 weeks). the median patient, health systems and total delays were 42, 2, and 44 days respectively for all the patients. marital status, being knowledgeable about tb, distance to clinic and where help is sought first had significant effect on patient delay. Conclusion: patient delay is the major contributor to delay in diagnosis and initiation of treatment of ptb among our patients. therefore tb control programmes in this region must emphasise patient education regarding symptoms of tuberculosis and timely health seeking behaviour.