Factors associated with early and late diagnosis of tuberculosis: a descriptive study

Furlan, Mara Cristina Ribeiro; Silva, Regina Lúcia Dalla Torre; Marcon, Sônia Silva

doi:10.5935/1676-4285.20144364

Cited by 7 publications

(13 citation statements)

References 10 publications

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“…4). Qualitative studies highlighted limitations for women to seek healthcare [113,115,123,124,128]. Women reported economic constraints and power imbalances in the decision-making process as barriers to care-seeking [113,115,123,124].…”

Section: Patient Delaymentioning

confidence: 99%

“…Bangladesh [113,114], Brazil [127,128], Cambodia [115], China [133,134], Ethiopia [108], India [113,119], Nigeria [123], Philippines [124], Russia[135], South Africa [137][138][139][140][141][142], Tanzania [112], Zambia [125], Zimbabwe [126] Perceived stigma and discrimination at workplace, within family and the community against women, and associating TB with HIV deterred presumptive TB cases from seeking TB diagnosis and care "When someone says, 'I have TB' others will say that the person has three words [HIV].'' [141] "The person would be scared that she would lose her job and that people and friends would avoid her."…”

Section: Patient Delaymentioning

confidence: 99%

“…[120] "There was poor adherence of the doctors to the recommended algorithm for investigating a patient suspected to have TB." [116] Brazil [128,130], China [131], India [94,117], Philippines [124], South Africa [142] Complicated procedures at the health facilities to reach TB diagnosis "Referrals from public day or tertiary hospitals to clinics were not managed smoothly and receiving clinics frequently seemed to question the referral and/or diagnosis, sending the patient away without treatment or referring the patient on to another service provider." [142] Brazil [127,128,130], India [94], Russia [136], South Africa [142] Lack of resources and materials in the health facilities led to a delay in TB diagnosis "Very often we do not have enough doctors or nurses in the medical sites.…”

Section: Patient Delaymentioning

confidence: 99%

“…Twelve qualitative studies reported that poor practices and ignorance of TB among health providers at health facilities led to a delay in TB diagnosis [108, 109, 112, 114, 116, 120-122, 127, 130, 131, 133]. Seven qualitative studies identified that complicated administrative procedures at the health facilities [94,117,124,128,130,131,142], which could have resulted in longer waiting time [42], and complex referral system [142] that eventually prolonged health system delay. This review identified that visiting lower-level facilities and those that did not provide TB services [30,42,68,71,88] was associated with health system delay.…”

Section: Health System Delaymentioning

confidence: 99%

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Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

Teo¹,

Singh

Prem

et al. 2020

Preprint

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Background: Globally, 30 countries with the highest tuberculosis (TB) burden bears 87% of the world’s TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the determinants and duration of delayed diagnosis and treatment of pulmonary TB in high TB burden countries. Methods: We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. For quantitative studies, we performed narrative synthesis of the covariates that were significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. Results: We included 124 articles from 14 low-and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC) in this review. The pooled median duration of patient, health system, and treatment delay were 28 days (95%CI 20–30), 11.5 days (95%CI 3.9–24.7), and six days (95%CI 1–28.4), respectively. We found that the duration of delays was consistently shorter among UMIC compared to LIC and LMIC. There was consistent evidence that being female and rural residence was associated with longer patient delay. Furthermore, patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Health system and treatment delay were mediated by organizational and policy factors. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high burden countries. Conclusions: This review detailed the determinants of delayed TB diagnosis and treatment in high burden countries. The gaps identified at different socio-ecological levels could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care.

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Section: Patient Delaymentioning

confidence: 99%

Section: Patient Delaymentioning

confidence: 99%

Section: Patient Delaymentioning

confidence: 99%

Section: Health System Delaymentioning

confidence: 99%

See 2 more Smart Citations

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

Teo¹,

Singh

Prem

et al. 2020

Preprint

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“…A equipe multiprofissional, formada minimamente por médico, enfermeiro, agente comunitário de saúde e técnico de enfermagem, desempenha importante papel no manejo da tuberculose, tendo como funções busca ativa e identificação dos sintomáticos respiratórios, orientação com relação ao tratamento e enfrentamento da doença e estratégias para a realização de diagnóstico precoce. Isso é dificultado pela "inabilidade dos profissionais de saúde" em identificar a doença, seus sinais e sintomas, além da atuação de forma não integral e humanizada, pela sobrecarga dos serviços de saúde e a falta de investimentos em uma política de saúde pública organizada se tornam um empecilho para essa investigação [10][11][12] .…”

Section: Introductionunclassified

Tuberculose: os futuros profissionais de saúde são preparados para o atendimento adequado do paciente?

et al. 2018

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Introduction: According to the World Health Organization (WHO), one third of the world’s population is infected with Mycobacterium tuberculosis(1). The literature shows that the multiprofessional team responsible for managing tuberculosis is not able to dealing with re-emergence of the disease, in addition acting in non-integral and humanized way. Objective: To check if university students that will be inserted in primary care are able to identify and manage patients with tuberculosis. Methods and materials: Semi-structured questionnaires were applied to students of the last periods of health courses. Data were analyzed through descriptive statistics. Results: Most of the interviewees said they have already had contact with the topic tuberculosis during graduation. Regarding the manifestations, 65 (38.24%) considered cough, weight loss, fever, loss of appetite, nocturnal sweating and weakness as the main symptoms of pulmonary tuberculosis. In contrast, 97 (57.06%) considered the presence of hemoptoic sputum as the main manifestation. The minority of the interviewees knew how to correctly define a respiratory symptomatic subject. Conclusion: Through the analysis of the results it is possible to notice that the university is the main source of knowledge of the university students about tuberculosis. One had identified gaps to be filled, as in relation to the manifestations of the disease, the difficulty in identifying a respiratory symptomatic subject, the lack of knowledge of the change in the vaccination schedule and mandatory rapid HIV testing. In addition, it is noticed that there is difficulty in the adequate management of the patients. In view of the results, there is a need to improve teaching in relation to tuberculosis.

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Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis

Taylor,

Medley,

van Wyk

et al. 2024

Cochrane Database of Systematic Reviews

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Background Active case finding (ACF) refers to the systematic identification of people with tuberculosis in communities and amongst populations who do not present to health facilities, through approaches such as door‐to‐door screening or contact tracing. ACF may improve access to tuberculosis diagnosis and treatment for the poor and for people remote from diagnostic and treatment facilities. As a result, ACF may also reduce onward transmission. However, there is a need to understand how these programmes are experienced by communities in order to design appropriate services. Objectives To synthesize community views on tuberculosis active case finding (ACF) programmes in low‐ and middle‐income countries. Search methods We searched MEDLINE, Embase, and eight other databases up to 22 June 2023, together with reference checking, citation searching, and contact with study authors to identify additional studies. We did not include grey literature. Selection criteria This review synthesized qualitative research and mixed‐methods studies with separate qualitative data. Eligible studies explored community experiences, perceptions, or attitudes towards ACF programmes for tuberculosis in any endemic low‐ or middle‐income country, with no time restrictions. Data collection and analysis Due to the large volume of studies identified, we chose to sample studies that had 'thick' description and that investigated key subgroups of children and refugees. We followed standard Cochrane methods for study description and appraisal of methodological limitations. We conducted thematic synthesis and developed codes inductively using ATLAS.ti software. We examined codes for underlying ideas, connections, and interpretations and, from this, generated analytical themes. We assessed the confidence in the findings using the GRADE‐CERQual approach, and produced a conceptual model to display how the different findings interact. Main results We included 45 studies in this synthesis, and sampled 20. The studies covered a broad range of World Health Organization (WHO) regions (Africa, South‐East Asia, Eastern Mediterranean, and the Americas) and explored the views and experiences of community members, community health workers, and clinical staff in low‐ and middle‐income countries endemic for tuberculosis. The following five themes emerged. • ACF improves access to diagnosis for many, but does little to help communities on the edge. Tuberculosis ACF and contact tracing improve access to health services for people with worse health and fewer resources (High confidence). ACF helps to find this population, exposed to deprived living conditions, but is not sensitive to additional dimensions of their plight (High confidence) and out‐of‐pocket costs necessary to continue care (High confidence). Finally, migration and difficult geography further reduc...

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Factors associated with early and late diagnosis of tuberculosis: a descriptive study

Cited by 7 publications

References 10 publications

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

Tuberculose: os futuros profissionais de saúde são preparados para o atendimento adequado do paciente?

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis

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