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

Hamza, A Aziz; Demissie, Meaza; Gare, Sisay; Teshome, Getu

doi:10.4236/oalib.1101947

Cited by 19 publications

(43 citation statements)

References 25 publications

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“…The observed median total delay in our study is lower than that reported from an earlier study conducted in a comparable setting in the Amhara Region of Ethiopia [ 5 ], but higher than the study findings reported from other regions of Ethiopia [ 7 , 9 , 19 ]. It is also higher compared to the studies done in Nepal [ 21 ], Angola [ 39 ], Zimbabwe [ 40 ] and South Africa [ 41 ].…”

Section: Discussioncontrasting

confidence: 87%

“…Patients with total delay of > 60 days were found to be more likely to have unfavorable treatment outcome than patients with total delay of ≤ 60 days. Long delays in diagnosis and treatment start contribute to severity and complications of illness that may result in poor treatment outcomes [ 19 , 20 ]. It also increases the risk of developing anti-TB drug resistance leading to increased mortality rate, treatment failure and transmission of drug resistant TB strains in the community [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

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Total Delay Is Associated with Unfavorable Treatment Outcome among Pulmonary Tuberculosis Patients in West Gojjam Zone, Northwest Ethiopia: A Prospective Cohort Study

2016

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Backgrounddelay in diagnosis and treatment of tuberculosis (TB) may worsen the disease, increase mortality and enhance transmission in the community. This study aimed at assessing the association between total delay and unfavorable treatment outcome among newly diagnosed pulmonary TB (PTB) patients.MethodsA prospective cohort study was conducted in West Gojjam Zone, Amhara Region of Ethiopia from October 2013 to May 2015. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study from 30 randomly selected public health facilities. Total delay (the time period from onset of TB symptoms to first start of anti-TB treatment) was measured. Median total delay was calculated. Mixed effect logistics regression was used to analyze factors associated with unfavorable treatment outcome.ResultsSeven hundred six patients were enrolled in the study. The median total delay was 60 days. Patients with total delay of > 60 days were more likely to have unfavorable TB treatment outcome than patients with total delay of ≤ 60 days (adjusted odds ratio [AOR], 2.33; 95% confidence interval [CI], 1.04–5.26). Human immunodeficiency virus (HIV) positive TB patients were 8.46 times more likely to experience unfavorable treatment outcome than HIV negative TB patients (AOR, 8.46; 95% CI, 3.14–22.79).ConclusionsLong total delay and TB/HIV coinfection were associated with unfavorable treatment outcome. Targeted interventions that can reduce delay in diagnosis and treatment of TB, and early comprehensive management of TB/HIV coinfection are needed to reduce increased risk of unfavorable treatment outcome.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Total Delay Is Associated with Unfavorable Treatment Outcome among Pulmonary Tuberculosis Patients in West Gojjam Zone, Northwest Ethiopia: A Prospective Cohort Study

2016

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“…e finding is similar to some studies conducted in Ethiopia which reported median of 30 days [9,25]. On the contrary it was lower than other local studies that showed a median of 56 days [15], 40 days in Arsi Zone [16], 60 days in Bahirdar [17], 70.5 days in Afar [18] and also elsewhere, 50 days in Nepal [19]. is may be explained by the difference in access to health service and quality of services; these studies were conducted in the rural parts of Ethiopia where health seeking behaviour and access are likely to be low.…”

Section: Discussionsupporting

confidence: 88%

Time Interval for Diagnosis of Tuberculosis and Related Expenditure in Selected Health Centers in Addis Ababa, Ethiopia

Shimeles

Tilahun

Hailu

et al. 2019

Advances in Public Health

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Background. Tuberculosis (TB) has continued to be a major health problem globally, in spite of the efforts to improve the diagnosis, treatment, and prevention. It affects millions of people each year and stands as the second cause of death due to infectious disease in the world. Early case finding and timely initiation of treatment is essential to ensure effective control of the disease as late diagnosis and treatment can aggravate the disease and result in poor outcomes and increase chances of transmission. Although TB services are supposed to be provided free of charge, TB affected families incur different types of costs in the process of seeking care, which might include health and nonhealth related costs. TB programs need to identify the underlying factors for delay and related expenditure for TB related services, in order to devise an effective strategy to reduce them. Therefore, the study aimed to assess the time interval between developing TB symptom until patients start anti-TB treatment and associated cost incurred by patients and families. Methods. This cross-sectional study was conducted among pulmonary TB patients who are bacteriologically confirmed, whose age is above 15 years and diagnosed at health centres in Addis Ababa. Results. The median time interval between onset of symptom and commencement of treatment was 4 weeks (IQR: 3, 6). Most patients with TB symptoms visited several health facilities before the final diagnosis was confirmed, the median number of visits being two, and only 48.8% were diagnosed on their first visit. Hence, they spent a lot of their limited resource in search of getting the right diagnosis. The total combined expenditure for all the visits was estimated to be median (IQR) 172.65 birrs (12, 671). Two variables were found to show statistically significant association with higher expenditure. Respondents who have good level of knowledge about TB are less likely to spend more than the median expenditure almost by a fifth compared to those with limited knowledge on TB, (adjusted odds ratio (AOR) = 0.2, with 95% confidence interval (CI): 0.06, 0.84). Patients who visited public hospitals were almost three times and those who visited private health facilities almost four times more likely to pay more than the median total expenditure, compared to those who visited health centre, AOR (95% CI) = 2.8 (1.53, 5.19) and AOR (CI) of 3.86 (1.06, 14.03), respectively. Conclusion. Patients with TB symptoms visit several health facilities till they are diagnosed, the median duration from onset of symptom till commencement of TB treatment being 4 weeks. It was noted that they face major expenses in the process of navigation to the right care. Two variables had statistically significant association with high pre-diagnosis expenditure, where patients with good level of knowledge about TB are less likely to spend more than the median, while patients who visited public hospitals or private health facilities had very high expenses. Improved public awareness about TB, minimizing service charges and other related fees, and further improvement in increasing access to services could reduce the length of time and expense for TB patients and their families. It is recommended to build capacity of health service providers to update them on programmatic approaches and latest diagnostic algorithm. It is important to strengthen public private partnership for TB services.

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“…Poor knowledge of TB is associated with patient delay. The association between poor knowledge of TB and patient delay is very strong as is also the case in other studies from Bahir Dar, Tigray, Somali and Uganda [20,22], [23,24]. Financial constraints for transportation were associated with patient delay in this study.…”

Section: Discussionsupporting

confidence: 82%

Patient Delay and Associated Factors Among Pulmonary Tuberculosis Patients at Hadiya Zone Public Health Facilities in South Ethiopia, 2017

Getahun¹

2018

EJCBS

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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 cut-off 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.

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

Cited by 19 publications

References 25 publications

Total Delay Is Associated with Unfavorable Treatment Outcome among Pulmonary Tuberculosis Patients in West Gojjam Zone, Northwest Ethiopia: A Prospective Cohort Study

Total Delay Is Associated with Unfavorable Treatment Outcome among Pulmonary Tuberculosis Patients in West Gojjam Zone, Northwest Ethiopia: A Prospective Cohort Study

Time Interval for Diagnosis of Tuberculosis and Related Expenditure in Selected Health Centers in Addis Ababa, Ethiopia

Patient Delay and Associated Factors Among Pulmonary Tuberculosis Patients at Hadiya Zone Public Health Facilities in South Ethiopia, 2017

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