Health care seeking behavior and patient delay in tuberculosis diagnosis

Almeida, Carlos Podalírio Borges de; Skupien, Erika Cavalheiro; Silva, Denise Rossato

doi:10.1590/0102-311x00195413

Cited by 30 publications

(25 citation statements)

References 17 publications

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“…It probably depends on the local health services and the local epidemiological situation, with a shorter delay to be expected when incidence is high [22]. In our study, we used a cut-off interval of 20 days for subsequent analysis which was similar to that found by other authors in TB [7, 23–25]. Second, considering that it was difficult to access to the results of previous CSF examinations and remarkable difference existed in the principles of CSF assays between hospitals, these results of CSF examinations performed at our hospital were used, which may have overestimated the clinical severity.…”

Section: Discussionmentioning

confidence: 76%

Total delay in treatment among tuberculous meningitis patients in China: a retrospective cohort study

Han

Chang

et al. 2017

BMC Infect Dis

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BackgroundCurrently, there is limited data on the risk factors associated with treatment delay in tuberculous meningitis (TBM). This study aimed to assess the duration of delay in the treatment TBM and to investigate its determinants.MethodsDuring the period from September 2009 to February 2016, a retrospective cohort study of consecutive TBM patients admitted to our hospital was conducted to determine the risk factors associated with treatment delay in TBM. Treatment delay duration was defined as the time interval from onset of symptoms (by patient recall) to initiation of treatment and was stratified into two categories: ≤ 20 days, >20 days (median delay day is 20 days). Data collected included demography, comorbidity, cerebrospinal fluid (CSF) examinations and others. Univariable and multivariable logistic regression analysis was used to evaluate the determinants of treatment delay.ResultsA total of 161 TBM patients were included in our study, all were confirmed by CSF mycobacterial culture. The median treatment delay for all patients included in the study was 20 days [interquartile range, 14–60 days]. Multivariate analysis revealed that age (≤21 years old, OR = 0.202, 95% CI: 0.079, 0.521), fever (OR = 0.414, 95% CI: 0.180, 0.952), and headache (OR = 0.204, 95% CI: 0.095, 0.442) had significantly lower risk for treatment delay, while multiple healthcare contact (>3 times) (OR = 3.938, 95% CI: 1.326, 11.691) as well as CSF chloride (>111 mmol/L) (OR = 2.479, 95% CI: 1.143, 5.377) had significantly higher risk of the delay.ConclusionsOur findings indicate that multiple healthcare contact and high CSF chloride predict the risk of long delay, while young age, fever and headache are associated with short delay. Maintained focus on awareness of TBM in the population and in healthcare systems, and continuous implementation of diagnostic methods for TBM to detect the disease early, may reduce the mortality and morbidity.

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Section: Discussionmentioning

confidence: 76%

Total delay in treatment among tuberculous meningitis patients in China: a retrospective cohort study

Han

Chang

et al. 2017

BMC Infect Dis

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“…12 Previous studies have proved that treatment delay is the main hindering factor in the control of TB. For example, De Almeida et al, 13 Ward et al, 14 and Yimer et al 15 revealed that a single TB patient who remains untreated can infect from 10 to 15 people every year. Moreover, delay in TB treatment may result in further complications and poor health, thus increasing the risk of mortality.…”

Section: Introductionmentioning

confidence: 99%

Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program

Saqib

Ahmad

Amezcua‐Prieto

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Delay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances transmission of tuberculosis (TB) in the community. Therefore, this study aims to assess treatment delay and its associated factors among pulmonary TB patients in Pakistan. A cross-sectional study was conducted among 269 pulmonary TB patients in the district. Binary and multivariate logistic regressions were used to explore the factors associated with delay in TB treatment. Results reveal that most patients were from low socioeconomic backgrounds. For example, 74.7% were living in houses, 54.7% were from lowest the income group (< 250 US$/month), 60.2% married, 54.3% illiterate, 62.5% rural, 56.1% had no house ownership, and 56.5% had insufficient income for daily family expenditures. Significant delays were revealed by this study: 160 patients had experienced a delay of more than 4 weeks, whereas the median delay was 5 weeks. Results show that the most important reason for patient delay was low income and poverty (42.0%) followed by unaware of TB center (41.6), stigma (felt ashamed = 38.7%), and treatment from local traditional healers. Old age (adjusted odds ratio [AOR] = 6.6; 95% confidence interval [CI] = 1.63-26.95); and rural areas patients (AOR = 2.1; 95% CI = 1.15-3.71) were more likely to have experienced delay. However, the higher income and sufficient income category (AOR = 0.5; 95% CI = 0.31-0.95) were associated factors and less likely to experience delay in patient treatment. Integrative prevention interventions, such as those involving community leaders, health extension workers such as lady health workers, and specialized TB centers, would help to reduce delay and expand access to TB-care facilities.

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“…17 In a study reported from Brazil among TB patients weight loss, sex, household income associated negatively with patient delay. 18 Finding the reasons for delay is critical part of any effective TB control program. Patient delay may explain why many patients present with advanced disease and why a relatively high percentage of TB patients die.…”

Section: Discussionmentioning

confidence: 99%

Health seeking behavior and reasons for “patient‐related” diagnostic delay among pulmonary tuberculosis suspects attending designated microscopy centre of medical college in rural Puducherry

Pranavi

Mallika

Ganapathy

2017

Int J Community Med Public Health

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Background: The main strategy of modern TB control is early detection and treatment of sources of infection to reduce the duration of infectiousness. Delay in diagnosis has health provider factors and client factors. Health seeking behavior and reasons for TB diagnostic delay is important and which is one of the agenda for operational research under Revised National Tuberculosis Control Program (RNTCP). Methods: The present cross sectional study was conducted among 200 tuberculosis suspects attending the Designated Microscopy centre (DMC) of SMVMCH for a period of 2 months. Data was collected using a pre-designed questionnaire including sociodemographic details, health seeking behaviour, treatment delay and reasons for delay. Collected data was entered and analyzed in EPI_INFO (3.4.3). Descriptive statistics and significant association was established by the use of odd’s ratio with 95% confidence interval. Results: Among the study subjects most of them were between the age group of 15 to 60 years and majority of them were male. Symptoms about tuberculosis was known only to 40(20%) of the suspects and 85(42.5%) accepted that tuberculosis is a curable disease. Among the various factors leading to patient related diagnostic delay age, marital status and multiple symptoms shows significant association. The most common reason for the delay is not aware of the severity of the symptoms 126(63%). Conclusions: There is poor knowledge about tuberculosis, its modes of spread and symptoms among Tb suspects. Patient related delays also common among them which warrant need for public health interventions to improve it.

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Health care seeking behavior and patient delay in tuberculosis diagnosis

Cited by 30 publications

References 17 publications

Total delay in treatment among tuberculous meningitis patients in China: a retrospective cohort study

Total delay in treatment among tuberculous meningitis patients in China: a retrospective cohort study

Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program

Health seeking behavior and reasons for “patient‐related” diagnostic delay among pulmonary tuberculosis suspects attending designated microscopy centre of medical college in rural Puducherry

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