Determinants of Patient Delay in Diagnosis of Pulmonary Tuberculosis in Somali Pastoralist Setting of Ethiopia: A Matched Case-Control Study

Abstract

Background: Healthcare-seeking behavior is the basis to ensure early diagnosis and treatment of tuberculosis (TB) in settings where most cases are diagnosed upon self-presentation to health facilities. Yet, many patients seek delayed healthcare. Thus, we aimed to identify the determinants of patient delay in diagnosis of pulmonary TB in Somali pastoralist area, Ethiopia. Methods: A matched case-control study was conducted between December 2017 and October 2018. Cases were self-presented and newly diagnosed pulmonary TB patients aged ≥ 15 years who delayed > 30 days without healthcare provider consultation, and controls were patients with similar inclusion criteria but who consulted a healthcare provider within 30 days of illness; 216 cases sex-matched with 226 controls were interviewed using a pre-tested questionnaire. Hierarchical analysis was done using conditional logistic regression. Results: After multilevel analysis, pastoralism, rural residence, poor knowledge of TB symptoms and expectation of self-healing were individual-related determinants. Mild-disease and manifesting a single symptom were disease-related, and >1 h walking distance to nearest facility and care-seeking from traditional/religious healers were health system-related determinants of patient delay > 30 days [p < 0.05]. Conclusion: Expansion of TB services, mobile screening services, and arming community figures to identify and link presumptive cases can be effective strategies to improve case detection in pastoral settings.

<p>Longer Delays in Diagnosis and Treatment of Pulmonary Tuberculosis in Pastoralist Setting, Eastern Ethiopia</p>

“…The disparities might be due to contrasts in demographics, socioeconomics, access to health services, and cognitive aspects. 31,32 Moreover, patient delay was notably longer among pastoralists than counterparts in the study and elsewhere. 13,28 The underlying cause could be due to the limited access to healthcare in the pastoralist setups of the country, and the nature of lifestyle that forces them to move from place to place making access to healthcare difficult.…”

“…15 Total delays were attributable to factors influencing patients' healthcare-seeking behavior and the healthcare system's efficiency to examine TB cases. The determinants of patient delay are available in a related study; 31 whereas, health system delay ≥15 days was associated with clinical features and first visit to health centers. Patients with mild symptoms at first presentation experienced health system delay compared to those who presented with hemoptysis, chest pain, fever, and dyspnea.…”

Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis

“…2 ). Among nine studies that examine the association between knowledge about TB and patients delay, a significant result was reported by six studies [ 9 , 11 , 12 , 16 – 18 ]. Our pooled analysis showed that patient delay is more likely among patients who had poor knowledge about TB (OR: 2.85, 95%CI: 1.49–5.47) (Fig.…”

“…Fourteen studies examined the association between residence and patient delay in the diagnosis of TB. Consequently, a significant association between residence and patient delay was reported by eight studies [8][9][10][11][12][13][14][15]. Patients living in the rural area had prolonged delay compared to patients living in urban area.…”

“…The average time of patient delay in the diagnosis of TB and its determinants were reported by a number of studies [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. However, the reported average time and determinant factors in these fragmented studies vary depending on the characteristics of study participants, the type of design employed and the variables analyzed.…”