Factors associated with DELAY in diagnosis among tuberculosis patients in Hohoe Municipality, Ghana

Abstract

BackgroundAny delay in diagnosis and consequently treatment of TB patients not only increases the infectivity of the disease in the community, but may also lead to more advance disease state, which may result in more complications and expose patients to higher risk of death. The aim of this study was to assess delays in diagnosing new TB patients and the factors associated with these delays in Hohoe Municipality of Ghana.MethodsA cross sectional study was carried out among 73 new TB Patients, 15 years or older, registered between 1st June, 2013 and 31st May, 2014 in Hohoe Municipality. Questionnaires were administered to patients to evaluate factors related to delay by patients in seeking care, delays at healthcare facilities, and total diagnostic delay. Logistic regression was used to determine the factors associated with patient delay (>30 days), healthcare services delay (>15 days), and total delay (>45 days).ResultsThe median total delay was 104 days (inter-quartile range (IQR):17–191). The median patient delay was 59 days (IQR: 5–123), and the median healthcare services delay was 45 days (IQR: 38–128). Not medically insured (AOR = 6.12; 95 % CI: 1.26–29.88; P < 0.025) and perceived stigma (AOR = 5.30; 95 % CI: 1.33–21.18; P < 0.018) were risk factors associated with prolonged patient delay. Multiple healthcare contact following signs and symptoms (AOR = 10.26; 95 %CI: 2.95–35.72; P < 0.0001) was the only risk factor associated with prolonged healthcare services delay.ConclusionThere is a considerable delay in TB case detection mainly due to patients delay in seeking healthcare. The factors associated with patients’ delay include lack of medical insurance, perceived stigma, and making multiple healthcare encounters. Health system strengthening towards decentralizing TB diagnosis and management, raising public awareness about the disease, training of healthcare providers, and collaborating with non-formal healthcare providers may reduce long delays in the management of TB.

Do Xpert MTB/Rif Cycle Threshold Values Provide Information About Patient Delays for Tuberculosis Diagnosis?

“…This was in agreement with a previous study that found rural residence as a risk factor of patient delay for TB diagnosis [13,27]. Previous studies documented HIV-positive individuals to have less patient delay compared to HIV-negative [12,28]. Previous studies have noted that HIV-positive individuals are more likely to suffer serious TB symptoms which prompt them to seek care earlier than HIV-negative individuals [26,28].…”

“…By the time of enrolment the patient could have had several diagnostic visits to the clinic where the current TB diagnosis was made, as well as sought care from several health services providers. For these reasons as well as the wide variation in literature about patient delay for TB diagnosis [6,7,8,9,10,11,12,13,14], we operationalized long delay to be ! 60 days with TB symptoms before TB diagnosis before TB diagnosis before current study data analysis.…”

“…Ct values have been found to predict decreasing bacterial burden with increasing immunosuppression and a combination of Ct values and sputum smear status to be a possible measure of bacterial burden in high HIV-burden settings [5]. Several studies have documented the various factors associated with patient delay for TB diagnosis [6,7,8,9,10,11,12,13,14]. Mycobacterial load is likely to increase with patient delay since bacillary burden has been found to grow over time and may have an impact on the novel diagnostic tests [15,16].…”

Diagnostic delay among adults with pulmonary tuberculosis in a high gross domestic product per capita country: Reasons and magnitude of the problem

“…Interestingly, despite this substantial delay, Qatar seems to compare favorably with both developed and developing countries with regard to the median total diagnostic delay. For example, the median total delays of PTB diagnosis in New York (USA), France, Norway, and Turkey are 57, 68, 63, and 49 days, respectively,[10111213] while in Ethiopia, Nepal, and Ghana are 80, 60, and 104, respectively[141516] with the highest median delay of 126 days reported in Tanzania. [4] Nevertheless, data from each of these countries may not necessarily represent the entire country, and the significant delay in PTB diagnosis in Qatar (despite the highly effective National TB Program and the free high standard public health system) remains striking.…”

Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study

“…Diagnostic and treatment delays contribute to increased TB transmission and severity of illness [3]. Delay in diagnosis and treatment of TB has been studied in various parts of the world.…”