Delay for Tuberculosis Treatment and Its Predictors among Adult Tuberculosis Patients at Debremarkos Town Public Health Facilities, North West Ethiopia

Ayalew, Y; Yehualashet, Fikadu Ambaw; Bogale, Worknesh Akanaw; Gobeza, Mengistu Berhanu

doi:10.1155/2020/1901890

Cited by 11 publications

(20 citation statements)

References 25 publications

(42 reference statements)

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“…IDPs showed a prolonged delay in seeking care because 73.1% of TB patients lean towards less expensive nonformal health services and 37.6% practiced self-medication, both leading to poor treatment outcomes. This is in line with the finding of previous studies conducted in conflict and non-conflict regions that non-formal healthcare providers play a significant role in delay [46][47][48]. Furthermore, a significant association was observed between self-medication and delay, which is consistent with previous studies conducted [49][50].…”

Section: Discussionsupporting

confidence: 92%

Impact of Protracted Displacement on Delay in the Diagnosis Associated with Treatment Outcomes: A Cross-sectional Study in Internally Displaced Tuberculosis Patients of Pakistan

Khan¹,

Khan²,

Hayat³

et al. 2021

Preprint

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Human displacement is on the rise globally, and the increase in the burden of tuberculosis (TB) is also attributed to migrations worldwide. A significant number of such displacement occur in regions with considerably higher areas of TB burden. Displacements may delay in TB diagnosis and treatment, which possibly will lead to TB transmission among healthy individuals. In this study, we assessed the association of existing determinants after a protracted internal displacement of people with the delay in TB diagnosis and treatment outcomes. A cross-sectional study was conducted on internally displaced TB patients registered at selected health facilities in three urban districts of Pakistan from March 2019 to February 2020. The univariate and multivariate logistic regression model was used to assess the delay in diagnosis and treatment outcomes. IDPs with delay in initiation of treatment beyond 30 days were at high possibility of unsuccessful TB treatment outcomes (adjusted odds ratio AOR,2.60; 95% CI 1.06-6.40). Analysis of factors that affect health seeker behavior and timely treatment showed a significant association (p<0.05) in-between age group 55-65 years (AOR, 2.66; 95% CI 1.00-7.07), female patients (AOR, 2.42; 95% CI 1.21-4.81), visited non-formal health provider (AOR, 8.81; 95% CI 3.99-19.46), self-medication (AOR, 2.72; 95 % CI 1.37-5.37), poor knowledge of TB (AOR, 11.39; 95% CI 3.31-39.1), and perceived stigma (AOR, 8.81; 95% CI 3.99-19.4). Prolong delay in treatment was associated with unfavorable treatment outcomes among IDPs, more specifically. As migrants and IDPs are more likely to experience an interruption in care due to overall exclusion from social and health care services. Therefore, it is imperative to understand the barriers in providing public health care services, particularly in preventing and treating TB.

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Section: Discussionsupporting

confidence: 92%

Impact of Protracted Displacement on Delay in the Diagnosis Associated with Treatment Outcomes: A Cross-sectional Study in Internally Displaced Tuberculosis Patients of Pakistan

Khan¹,

Khan²,

Hayat³

et al. 2021

Preprint

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“…the other hand, the prevalence of treatment seeking delay was shorter than previous studies in Ethiopia [17,28,31] and higher than other reports from Ethiopia [30,40,41]. This might be partly due to lack of awareness and traditional medicinal practices across different region of Ethiopia [28].…”

Section: Plos Onementioning

confidence: 55%

Treatment seeking delay and associated factors among tuberculosis patients attending health facility in Ethiopia from 2000 to 2020: A systematic review and meta analysis

et al. 2021

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Background Treatment seeking delay is defined as the time interval between the onset of the major symptoms of tuberculosis (TB) and the first visit to the formal health care facility. The patient was said to be delayed if the patient visited the health-facility after 3 weeks onset of major symptoms. However, in low-income countries like Ethiopia, the delay in treatment-seeking among tuberculosis patients contributes to a widespread transmission and high prevalence of tuberculosis. Methods Studies were retrieved from PubMed, Cochrane Database, Cinahl, Scopus, Mednar, and Google Scholar by employing a combination of search terms with Boolean operators. Heterogeneity across studies was assessed using the Cochrane Q test. A funnel plot was used for visual assessment of publication bias. Subgroup analyses were performed to explore the possible causes of heterogeneity. Egger’s weighted regression test at a p-value < 0.05 was used to assess the presence of publication bias. Sensitivity analysis was performed to judge whether the pooled effect size was influenced by individual study. STATA software version 14 was used for all statistical analyses. Result A total of 12 studies with 5122 total sample size were included. The national pooled prevalence of treatment seeking delay was 44.29% (95% CI: 39.805, 48.771). The visual inspection of the funnel plot showed the asymmetrical distribution, and the Egger test showed insignificant (P = 0.348). Patients who did not seek formal health care providers on a first contact had about 7 times more likely to delay than patients who sought formal health care provider on a first contact (OR: 7.192 ((95% CI 5.587–9.257), P = 0.001, I2: 85%). The others independent predictors of delay were rural residence (OR: 3.459 ((95% CI 1.469–8.148), P ≤ 0.001), extra pulmonary TB (OR: 2.520 ((95% CI 1.761–3.605), 0.180), lower educational level (OR 11.720 ((95% CI 1.006–2.938), P <0.001), and distance more than 10km from health facility (OR: 1.631 ((95% CI (10.858–3.101), P = 0.001). Conclusion In this review, we identified a substantial treatment seeking delay among TB patients in Ethiopia. And, the independent predictors of delay were treatment sought before formal health care provider, residence of the patient, type of TB, educational level, and distance from a health facility. Thus, we recommend health extension workers, health professionals and other stakeholders to focus on patient education, and to continuously mobilize the whole communities on early treatment seeking with a special emphasis given to where treatment sought before formal health care provider, rural resident, extra pulmonary TB, and a patient living farther than 10km distance from health facility.

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“…The smallest median health system delay among studies included in the analysis was 4 days [11] and the longest was 34 days [35]. The overall estimated pooled median health system delay was 15.29 (95% CI: 9.94-20.64) days.…”

Section: Meta-analysismentioning

confidence: 93%

“…The included articles covered 9 regions with two city administrations; the majority of the studies were conducted in Amhara region [7,11,[47][48][49][50]. Five studies [35,[50][51][52][53] enrolled pulmonary tuberculosis patients, three studies [7,8,47] enrolled smear-positive PTB patients, and the remaining six studies [9-11, 48, 49, 54] enrolled both types of tuberculosis patients.…”

Section: Characteristics Of Original Studiesmentioning

confidence: 99%

“…Delay can be categorized as patient delay, health system delay (diagnostic and treatment delay), and total delay as the sum of patient delay and health system delay [7]. The majority of Ethiopian studies on health system delay [8][9][10][11] and a country assessment done in 2016, as well as the WHO 2006 report, defined health system delay as the interval from the first visit to a health care provider to the initiation of effective treatment and usually used the median value to categorize TB patients as delayed or not delayed [12,13]. Delay in diagnosis and treatment causes patients to be more likely to have advanced disease, complications, mortality, and increase ongoing person-to-person transmission in the community at large [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis

Tefera¹,

Wagnew²,

Belay³

et al. 2021

AJLM

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Delay in diagnosis and initiation of effective treatment associated with an increase in morbidity, mortality, and ongoing person-to-person transmission in the community at large. Several studies have been conducted in Ethiopia; however, studies assessing the health system's delay in treating tuberculosis patients have yielded inconsistent and inconclusive results. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. We systematically searched different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus, and Springer link databases for studies published from June 6,1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using a random-effects model in R version 4.0.3 software (for median estimation) and Stata version 14 (for metan). A total of 14 studies with 6161 patients who met predetermined criteria were included. Our meta-analysis showed that the estimated pooled median time of the health system delay was 15.29 (95%CI: 9.94-20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015, the pooled median health system delay was 21.63 (95% CI: 14.38-28.88) days, whereas in studies conducted after 2015, the pooled median time was 9.33 (95% CI: 3.95-14.70) days. Living in rural areas (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. In Ethiopia, this review highlights that patients were delayed more than two weeks in the treatment of tuberculosis. Being a rural resident, was the contributing factor of health system delay. For successful TB control, implementing efforts like providing regular health education to the community about TB emphasizes the rural community and enhancing the quality of care in TB treatment facilities in rural areas could have important implications to reduce health system delay.

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Delay for Tuberculosis Treatment and Its Predictors among Adult Tuberculosis Patients at Debremarkos Town Public Health Facilities, North West Ethiopia

Cited by 11 publications

References 25 publications

Impact of Protracted Displacement on Delay in the Diagnosis Associated with Treatment Outcomes: A Cross-sectional Study in Internally Displaced Tuberculosis Patients of Pakistan

Impact of Protracted Displacement on Delay in the Diagnosis Associated with Treatment Outcomes: A Cross-sectional Study in Internally Displaced Tuberculosis Patients of Pakistan

Treatment seeking delay and associated factors among tuberculosis patients attending health facility in Ethiopia from 2000 to 2020: A systematic review and meta analysis

Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis

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