Effects of integrating traditional and modern healthcare system on tuberculosis diagnosis delay in Ethiopia: a clustered randomized controlled study

Abstract

Background: Delay in tuberculosis (TB) diagnosis and treatment is a major challenge in low- and middle-income countries. We aimed to assess the effectiveness of a new approach of integrating traditional care with modern TB control programs in reducing delays in TB diagnosis and treatment. Methods: We conducted a cluster randomized control trial involving 23 health facilities across four districts and two town administrations in northwest Ethiopia. The clusters were randomly allocated with a 1:1 ratio to intervention or control groups. We provided training for traditional and modern healthcare providers in three different rounds to enhance their knowledge, attitude, and skills towards referral systems. We used shared frailty parametric survival analysis to investigate the relationship between the outcome and exposure variables. Results: A total of 510 participants (255 in each group) were included in the study. Delay was significantly decreased following the intervention (mean difference=23.678, P=0.008). The effect size of the intervention on patient delay, diagnosis delay, and total delays were 0.281, 0.211, and 0.213, respectively. The total delay was 4.578 per 1000 person-days. The delay in the intervention group was 4.185 per 1000 person-days and 5.031 per 1000 person-days in the control group. The median time to delay was 135 days (95% CI: 102, 223) and the total follow-up period was 55, 026 person-days of observation, with an average follow-up time of 107.894 days. The time to delay who had higher education was significantly decreased by 22.7% (δ=0.773; 95% CI: 0.617, 0.967) compared to the illiterates. Patients who travelled a far distance saw an increase of 1.026 units in delays as distance increased by one kilometer (δ =1.026; 95% CI: 1.007,1.046) compared to their counter parts. Participants with adequate knowledge significantly decreased the time to diagnosis delay by 30.4% compared to those with poor knowledge. Conclusion: The involvement of traditional care providers in the TB control program has led to a significant decrease in patient and diagnosis delays. Higher education, distance, and knowledge about TB were found to be significantly associated with diagnosis delay. These findings underscore the importance of integrating traditional and modern healthcare systems to effectively combat TB. Clinical trial registration · ClinicalTrials.gov ID: NCT05236452. · The date recruitment began: July 1, 2022. · Registration date: July 22, 2022.