Delay in Diagnosis of Tuberculosis among Under Treatment Patients in Rajshahi City, Bangladesh

Chowdhury, RK; Rahman, Shafiur; Mondal, Nazrul Islam; Islam, Rafiqul; Sayem, Md. Abu

doi:10.3126/saarctb.v11i2.12435

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Patients who lived more than 10 kilometers away from a health institution were more likely to delay more than 5 weeks in getting an EPTB diagnosis. Similar studies also reported the association between long-distance and delay of EPTB diagnosis [ 9 , 27 ]. This implies that limited accessibility of healthcare facilities could affect the implementation of TB programs and could delay the diagnosis of potentially infectious pulmonary TB [ 28 , 29 ].…”

Section: Discussionsupporting

confidence: 61%

Knowledge of symptoms and delays in diagnosis of extrapulmonary tuberculosis patients in North Shewa zone, Ethiopia

2022

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Introduction Delayed diagnosis contributes to the high burden and transmission of tuberculosis and extrapulmonary tuberculosis (EPTB) and continued to be a major public health problem in Ethiopia. Currently, there is insufficient knowledge on the contributing factors to diagnostic delay of EPTB patients in healthcare settings in Ethiopia, because of unique cultural and societal issues in this country. This study assessed patients’ knowledge of symptoms and contributing factors of delay in diagnosis of EPTB patients at selected public health facilities in North Shewa zone, Ethiopia. Methods An institutional-based study was conducted from March to April 2021. All recently registered EPTB patients were included. Logistic regression was performed to analyze the data. A significant association was declared at a p-value of < 0.05, and the results were presented with an adjusted odds ratio (AOR) and the corresponding 95% confidence interval (CI). Results In this study, only 15.5% of respondents knew EPTB symptoms. The median patient and healthcare system delay was 55 days. A patient delay of greater than 3 weeks and a health system delay of greater than 2 weeks were observed among 85.2% and 81% of patients, respectively. After the end of 5 weeks, 87.3% of EPTB patients had been diagnosed with the disease and the total median delay was 108.5 days. Living more than ten kilometers far from a health facility (AOR = 1.54; 95% CI = 1.11, 4.63), having never heard of EPTB disease (AOR = 5.52; 95% CI = 1.73, 17.56), and having ever taken antibiotics at the first health facility visit (AOR = 7.62; 95% CI = 2.26, 25.65) were associated with a total diagnostic delay of beyond 5 weeks. Conclusions The diagnostic delays of EPTB remain high. Both patient and health system delays equally contributed to the total diagnosis delay. Improving community awareness of EPTB and advancing diagnostic efficiencies of healthcare facilities could help reduce both delays.

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Section: Discussionsupporting

confidence: 61%

Knowledge of symptoms and delays in diagnosis of extrapulmonary tuberculosis patients in North Shewa zone, Ethiopia

2022

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“…Delays in TB diagnosis were also high in the Amhara region, with three-fifths of patients having delays in TB diagnosis and treatment [ 24 ]. The lack of appropriate intervention was the main contributor to the delay in TB diagnosis [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of integrating traditional care with modern healthcare to improve tuberculosis control programs in Ethiopia: a protocol for a cluster-randomized controlled trial

Amare,

Ambaw,

Alene

2023

Trials

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Background Tuberculosis (TB) remains a major cause of morbidity and mortality in the world, despite being a preventable and curable disease. The World Health Organization (WHO) End-TB Strategy, aligned with the Sustainable Development Goals (SDGs), sets a target of reducing the TB mortality rate by 95%, TB incidence rate by 90%, and catastrophic costs due to TB by 2035, compared with a 2015 level. To achieve these ambitious targets, several interventions have been implemented in the last few years, resulting in major progress toward reducing the burden of TB. However, over one-third of the global TB cases remained undetected and never received treatment. Most of those undetected cases were found in low- and middle-income countries such as Ethiopia. Though several interventions were implemented to increase TB case detection and mitigate catastrophic costs associated with TB, sustaining these interventions in resource-constrained settings remains challenging. Consequently, an alternative method is needed to increase TB case detection while decreasing diagnosis delays and catastrophic costs. Therefore, this study aimed to integrate traditional TB care into modern TB care to improve TB control programs, including early TB case detection, and reduce catastrophic costs in high TB burden settings such as Ethiopia. Methods A cluster randomized controlled trial will be conducted in northwest Ethiopia to determine the effectiveness of integrating traditional care with modern TB care. The intervention will be conducted in randomly selected districts in the South Gondar Zone. The control group will be an equal number of districts with usual care. The intervention comprised three key components, which include referral linkage from traditional to modern health care; training of health professionals and traditional care providers in three different rounds to increase their knowledge, attitude, and skills toward the referral systems; and TB screening at traditional health care sites. The primary outcomes of interest will be an increase in case detection rate, and the secondary outcomes of interest will be decreased diagnosis delays and catastrophic costs for TB patients. Data will be collected in both the intervention and control groups on the main outcome of interest and a wide range of independent variables. Generalized linear mixed models will be used to compare the outcome of interest between the trial arms, with adjustment for baseline differences. Discussion This cluster-randomized controlled trial study will assess the effectiveness of a strategy that integrates traditional healthcare into the modern healthcare system for the control and prevention of TB in northwest Ethiopia, where nearly 90% of the population seeks care from traditional care systems. This trial will provide information on the effectiveness of traditional and modern healthcare integration to improve TB case detection, early diagnosis, and treatment, as well as reduce the catastrophic costs of TB. Trial registration ClinicalTrials.gov NCT05236452. Registered on July 22, 2022.

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“…Despite this success, some patients continue to refuse, delay, or do not adhere to TB treatments [ 13 , 14 ]. The anthropologist Paul Mason said that one must go beyond the medical model of TB and acknowledge the socio-economic and cultural aspects of the disease to ensure its effective treatment and prevention [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis and the sexual and reproductive lives of women in Bangladesh

2018

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When they do not meet norms related to sexuality and reproduction, Bangladeshi women often face abandonment and are thus deprived of an active sexual life, a marital relationship, and motherhood. Little is known about how a stigmatised disease such as tuberculosis (TB) may constrain the reproductive health and sexual lives of women. This article, derived from a larger study on the impact of TB on women’s sexual and reproductive health and rights in Narsingdi district and Dhaka, Bangladesh, aims to fill this gap. Based on interviews with nine married women who have or had TB, four husbands, and two mothers-in-law, this article highlights that the ways in which TB impedes on the sexual and reproductive lives of women depends on the stigma within their family and community, their relationships with their husbands, motherhood, their living arrangements, their economic contribution to the family and/or their disclosure of their TB diagnosis. Women with children and supportive husbands retain a stronger position among their in-laws and are less likely to be isolated or rejected. The patients’ narratives revealed that the instructions of health workers influenced their decisions about intercourse or abstinence. Future studies should examine the instructions patients receive from health workers regarding their living and sleeping arrangements, sexual intercourse, and pregnancy, as well as policy documents on TB treatment and prevention.

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Delay in Diagnosis of Tuberculosis among Under Treatment Patients in Rajshahi City, Bangladesh

Abstract: Introduction: Delay in diagnosis regarding Tuberculosis (TB) is common in developing country as well as in Bangladesh. Therefore, the aim of the study is to identify the factors which have effects on delay in diagnosis.

Cited by 4 publications

References 21 publications

Knowledge of symptoms and delays in diagnosis of extrapulmonary tuberculosis patients in North Shewa zone, Ethiopia

Knowledge of symptoms and delays in diagnosis of extrapulmonary tuberculosis patients in North Shewa zone, Ethiopia

Effect of integrating traditional care with modern healthcare to improve tuberculosis control programs in Ethiopia: a protocol for a cluster-randomized controlled trial

Tuberculosis and the sexual and reproductive lives of women in Bangladesh

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