Time to first consultation, diagnosis and treatment of TB among patients attending a referral hospital in Northwest, Ethiopia

Abstract

BackgroundEarly detection and treatment of TB is essential for the success of TB control program performance. The aim of this study was to determine the length and analyze predictors of patients’, health systems’ and total delays among patients attending a referral hospital in Bahir Dar, Ethiopia.MethodsA cross-sectional study was conducted among newly diagnosed TB cases ≥ 15 years of age. Delay was analyzed at three levels: the periods between 1) onset of TB symptoms and first visit to medical provider, i.e. patients’ delay, 2) the first visit to a medical provider and the initiation of treatment i.e. health systems’ delay and 3) onset of TB symptoms and initiation of treatment i.e. total delay. Uni- and multi-variate logistic regression analyses were performed to investigate predictors of patients’, health systems’ and total delays.ResultsThe median time of patients’ delay was 21 days [(interquartile range (IQR) (7 days, 60 days)]. The median health systems’ delay was 27 days (IQR 8 days, 60 days) and the median total delay was 60 days (IQR 30 days, 121 days). Patients residing in rural areas had a three-fold increase in patients’ delay compared to those from urban areas [Adjusted Odds Ratio (AOR) 3.4; 95% (CI 1.3, 8.9)]. Extra-pulmonary TB (EPTB) cases were more likely to experience delay in seeking treatment compared to pulmonary (PTB) cases [(AOR 2.6; 95% (CI 1.3, 5.4)]. Study subjects who first visited health centres [(AOR) 5.1; 95% (CI 2.1, 12.5)], private facilities [(AOR) 3.5; 95% (CI 1.3, 9.7] and health posts [(AOR) 109; 95% (CI 12, 958], were more likely to experience an increase in health systems’ delay compared to those who visited hospitals.ConclusionsThe majority of TB patients reported to medical providers within an acceptable time after the onset of symptoms. Rural residence was associated with patients’ and total delays. Providing the population with information about TB symptoms and the importance of early health seeking may be an efficient way to decrease TB transmission, morbidity and mortality. Establishing efficient TB diagnostic and treatment facilities at the periphery level is imperative to reduce diagnostic delay and expedite TB treatment.

Delay in Tuberculosis Diagnosis among Tuberculosis Patients at the Three Hospitals: Asella, Robe and Abomsa of Arsi Zone, Oromia Regional State, March, 2015

“…Health service delay is longer than patient delay in one study from northern Ethiopia magnifying the contribution of health system to diagnosis delay [6].…”

“…Many studies tried to investigate factors for patient and health service delay. Patient delay was associated with literacy, rural residence, type of TB disease, occupation, nutritional status, self-treatment, first visit to non-formal health providers, the type of health facilities first visited by patients, Human Immune Virus(HIV) status, old age, sex and longer one way walking time to nearby health facility [1]- [6].…”

“…One study defined "patient delay" as the time interval between the onsets of TB symptoms-and the first formal or informal health care received [19]. Health system delay [6] [18], Medical provider delay [8] or Health service delay [15] was used to define the time interval from the first consultation at any formal health facility up to the date of diagnosis. Many other studies used the health system delay [3] [16] [20], health service delay [19] and health provider delay [7] more comprehensively to mean the time interval from first consultation up to treatment initiation.…”

“…The other studies [3] [8] [19] used median delay as cut-off points. As to the health service delay; one study from Chad [19], two studies from Ethiopia [3] [8] used median delay as cut-off point, where us the other three studies from Ethiopia used 7 days [7], 15 days [15] and 2 weeks [6] as cut-off point. One study used different cut-off points based on types of TB to measure health service delay as 5 days for SM+ TB and 10 days for SM− TB [22].…”

“…Prolonged patient delay is associated with literacy, rural residence, types of TB disease, occupation, age, sex and nutritional status [2]- [6]. Self-treatment, use of informal treatment prior to first consultation at public health facilities, number and type of provider first consulted are risk factors for the delay [3] [5] [28].…”