Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub‐Saharan African countries with high burdens of TB and HIV

Abstract

Summaryobjective To identify factors causing delayed diagnosis and treatment for tuberculosis in high tuberculosis (TB) ⁄ HIV burden African countries.methods We searched Ovid Medline, CINAHL, PsychInfo, Scopus and Sabinet-South African journals and reference lists, Google, Google Scholar and Google SA for reports in English, ‡1992, of original data from sub-Saharan countries on patient or system delay in TB diagnosis or treatment with populations ‡15 years old. Two reviewers extracted data independently for each study. We categorized independent variables as predisposing, enabling or reinforcing (PRECEDE model). Meta-analysis was conducted for factors associated with delay in ‡2 studies.results Of 20 eligible studies, 12 assessed both sources of delay; 1, system delay; and 7, patient delay only. Most were cross-sectional surveys (k = 13) with samples of consecutive patients (k = 13) and bivariate analyses (k = 11). Starting and endpoints for patient delay were consistent, but not system delay. Patient characteristics were studied frequently; HIV stigma and enabling factors were studied infrequently, although the last were most often associated with delay. Consulting traditional healers first -usually by rural residents -consistently led to patient delay; OR = 3.45 (1.91-6.21). Travel time for the return visit was consistently associated with system delay OR = 1.87 (1.378-2.531).conclusions We recommend partnerships with traditional healers and research emphasizing HIV and system factors, standard definitions of delay and qualitative and cohort studies to identify enabling and reinforcing factors related to delay.keywords tuberculosis, sub-Saharan Africa, health care-seeking behaviour, delivery of health care

Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems

“…[34][35][36] Although neither travel time nor distance was associated with likelihood of completing TB evaluation at these primary health clinics in Uganda, other studies have found that increased travel time as measured by self-report is associated with delays both in seeking and delivering TB care. 8 In the absence of more detailed individual covariates in our study, we propose several possible hypotheses for testing in future studies. One hypothesis is that patients traveling for a longer time period to access care may be wealthier or more motivated to complete evaluation than those traveling for a shorter period.…”

“…A number of qualitative studies have highlighted the contribution of geography and extended travel times to failures to complete TB evaluation and initiate treatment, 8 but there is little quantitative information in this area. Geographic information systems (GIS) methods allow investigators to create digital representations of the landscape to enable estimation of the distance that patients travel, a technique that is complementary to information obtained from patient reports and more scalable for data collection on large populations.…”

Acesso ao diagnóstico da tuberculose em município brasileiro de médio porte

“…Apesar de o município investir nas condições de vida, de moradia, escolaridade e de saúde, ainda persistem barreiras geográficas, socioculturais e econômicas que dificultam o acesso dos doentes aos serviços, pois esta população continua nas áreas periféricas, menos favorecidas e vulneráveis ao risco de desenvolver TB (1,3,9,10,15,16).…”

“…A demora na realização do diagnóstico agrava a situação dos doentes, que acabam sendo encaminhados aos níveis secundários e terciários de atenção, já em estado avançado da doença, com sérios comprometimentos da saúde (15,16).…”

The social determinants of knowledge and perception on pulmonary tuberculosis among females in Jakarta, Indonesia

“…Some considerable challenges, such as delayed care seeking and poor treatment compliance, 6,7 are resulted from limited community involvement in TB control program. TB programs within community are important to reduce risk infection and decline TB incidence in community.…”