Factors Associated With Delay in Diagnosis and Treatment of Pulmonary Tuberculosis

Alavi, Seyed Mohammad; Bakhtiyariniya, Pejman; Albagi, Ali

doi:10.5812/jjm.19238

Cited by 33 publications

(30 citation statements)

References 15 publications

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“…The findings from our study on pathways to care for TB in vulnerable urban settings in Mumbai, generally complement the findings of several studies undertaken in India [ 27 , 28 , 29 ] and elsewhere [ 30 , 31 , 32 , 33 ]. The largest contributor to the total duration of 65 days extending from the beginning of symptoms to the initiation of treatment, as reported by patients, was the time spent on obtaining the diagnosis of TB.…”

Section: Discussionsupporting

confidence: 85%

Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India

et al. 2016

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BackgroundTimely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai.MethodsA population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values.ResultsThe mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days) and retreatment patients (25 days). Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation.ConclusionAchieving positive behavioural changes in providers (especially non-allopaths) and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics would be singularly effective in curbing pathway delays.

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Section: Discussionsupporting

confidence: 85%

Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India

et al. 2016

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“…We found 11 studies had a low risk of bias (16,19-25a-25d), 7 had a moderate risk of bias (17,(26)(27)(28)(29)(30)(31) and 5 had a high risk of bias (18,(32)(33)(34)(35) (Tables 1,2). We considered the WHO report as a single study with coverage of 4 countries that met our inclusion criteria (25).…”

Section: Assessment Of Risk Of Biasmentioning

confidence: 84%

“…At least one factor attributing to patient delay was analysed in 10 studies (16,(18)(19)(20)(21)(22)(23)(24)(25)35). Studies mostly assessed predisposing factors such as patient sociodemographic characteristics, TB knowledge and perception about TB.…”

Section: Factors Associated With Patient Delaymentioning

confidence: 99%

Factors associated with tuberculosis diagnosis and treatment delays in Middle East and North Africa: a systematic review

Eltayeb

Pietersen

Engel

et al. 2020

East Mediterr Health J

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Background: Political instability, economic sanctions and substandard quality of health care negatively affect tuberculosis (TB) control in the Middle East and North Africa (MENA) region. Aims: We aimed to elucidate factors contributing to delays in TB diagnosis and treatment in MENA countries. Methods: Two reviewers independently appraised eligible articles identified through comprehensive searching and extracted data which were subjected to meta-analysis. Results: Delays in TB diagnosis were associated with older age and low income [(OR = 1.49; 95% CI: 1.31-1.70) and (OR = 1.26; 95% CI: 1.09-1.45)] respectively (n = 17 studies). Being female was associated with patient delay and health system delay [(OR = 1.24; 95% CI: 1.02-1.50) and (OR = 1.68; 95% CI: 1.18-2.38)] respectively. Knowledge and perception of TB, having employment and low levels of crowding were each protective against patient delay. The GRADE system rated the evidence as of low quality. Conclusion: This review provides evidence for facilitators and barriers to TB diagnosis and health system delays. For successful TB control in the MENA region, TB awareness and interventions targeting the elderly and those from lower-income settings, particularly directed at gender differences, are essential.

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“…The diagnostic delays observed in the studied patients are lower than those reported from EMR and countries of origin of the patients [7][8][9][10][11][12][13]. A systematic review of the Indian literature found that the patient, diagnostic and treatment delay were 18.4, 31.0 and 2.5 days, respectively, and the median total delay of 55.3 days [14].…”

Section: Discussionmentioning

confidence: 81%

Diagnosis Delay among Newly Tuberculosis Patients Admitted in a Community Hospital

Garcell¹,

Zenón²,

Arias³

et al. 2017

J Epid Prev Med

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Objective: To determine the diagnostic delay in newly diagnosed tuberculosis (TB) patients admitted to a community hospital in Qatar. Design:The study was conducted from January 2013 today 2016. The following information was collected from patient file: Age, sex, nationality, tuberculosis type, time of symptoms onset, time of the confirmatory test, and the time of visiting an HCP before the admission encounter.Results: Of the 390 TB patients included in the study, 281 (72.1%) were from South East Asian countries, 325 (83.3%) patients were males and 65 (16.7%) were females, mean age was 32.4 years. Of the 390 patients, 89.7% (350 patients) had pulmonary tuberculosis and 40(10.3%) patients had non-pulmonary localization. The median total delay was 30 days (15;60 days), while the patient delay was 10 days (4;27 days) and the system delay was 3 days (3;7.8 days). For pulmonary tuberculosis, the total delay was 30 days and for non-pulmonary localization was 15 days. Conclusion:The study provides an insight about the delay in the diagnosis of TB at a community hospital in Qatar. Additional studies should be conducted to evaluate the delay in a representative national sample and to identify the factors associated with patients' delays, which could be used to strengthen the national program for tuberculosis control.

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Factors Associated With Delay in Diagnosis and Treatment of Pulmonary Tuberculosis

Cited by 33 publications

References 15 publications

Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India

Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India

Factors associated with tuberculosis diagnosis and treatment delays in Middle East and North Africa: a systematic review

Diagnosis Delay among Newly Tuberculosis Patients Admitted in a Community Hospital

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