Factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia

Tedla, Kiros; Medhin, Girmay; Berhe, Gebretsadik; Mulugeta, Afework; Berhe, Nega

doi:10.1371/journal.pone.0235411

Cited by 12 publications

(15 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The findings of this study also revealed that level of information about tuberculosis and educational status were strongly associated with treatment seeking delay. Other studies conducted in Ethiopia reported lower educational level as an independent predictor of treatment seeking delay [29,47]. Patients who had poor information about TB were more likely to have longer patients delay than those who had good information about TB [57].…”

Section: Plos Onementioning

confidence: 90%

“…All of the included studies were cross-sectional studies. The sample size ranged from 1700 [25] to 875 [29]. The studies were conducted between 2013 and 2020 across the country.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…This might be due to low confidence in treatment in a health facility and high cultural beliefs of patients for treatment of TB. Besides, the use of some home remedies or antibiotics might reduce or mask the symptoms of the illness which might hinder the timely presentation of the patient to the health care facility [29].…”

Section: Plos Onementioning

confidence: 99%

See 2 more Smart Citations

Treatment seeking delay and associated factors among tuberculosis patients attending health facility in Ethiopia from 2000 to 2020: A systematic review and meta analysis

et al. 2021

View full text Add to dashboard Cite

Background Treatment seeking delay is defined as the time interval between the onset of the major symptoms of tuberculosis (TB) and the first visit to the formal health care facility. The patient was said to be delayed if the patient visited the health-facility after 3 weeks onset of major symptoms. However, in low-income countries like Ethiopia, the delay in treatment-seeking among tuberculosis patients contributes to a widespread transmission and high prevalence of tuberculosis. Methods Studies were retrieved from PubMed, Cochrane Database, Cinahl, Scopus, Mednar, and Google Scholar by employing a combination of search terms with Boolean operators. Heterogeneity across studies was assessed using the Cochrane Q test. A funnel plot was used for visual assessment of publication bias. Subgroup analyses were performed to explore the possible causes of heterogeneity. Egger’s weighted regression test at a p-value < 0.05 was used to assess the presence of publication bias. Sensitivity analysis was performed to judge whether the pooled effect size was influenced by individual study. STATA software version 14 was used for all statistical analyses. Result A total of 12 studies with 5122 total sample size were included. The national pooled prevalence of treatment seeking delay was 44.29% (95% CI: 39.805, 48.771). The visual inspection of the funnel plot showed the asymmetrical distribution, and the Egger test showed insignificant (P = 0.348). Patients who did not seek formal health care providers on a first contact had about 7 times more likely to delay than patients who sought formal health care provider on a first contact (OR: 7.192 ((95% CI 5.587–9.257), P = 0.001, I2: 85%). The others independent predictors of delay were rural residence (OR: 3.459 ((95% CI 1.469–8.148), P ≤ 0.001), extra pulmonary TB (OR: 2.520 ((95% CI 1.761–3.605), 0.180), lower educational level (OR 11.720 ((95% CI 1.006–2.938), P <0.001), and distance more than 10km from health facility (OR: 1.631 ((95% CI (10.858–3.101), P = 0.001). Conclusion In this review, we identified a substantial treatment seeking delay among TB patients in Ethiopia. And, the independent predictors of delay were treatment sought before formal health care provider, residence of the patient, type of TB, educational level, and distance from a health facility. Thus, we recommend health extension workers, health professionals and other stakeholders to focus on patient education, and to continuously mobilize the whole communities on early treatment seeking with a special emphasis given to where treatment sought before formal health care provider, rural resident, extra pulmonary TB, and a patient living farther than 10km distance from health facility.

show abstract

Section: Plos Onementioning

confidence: 90%

“…All of the included studies were cross-sectional studies. The sample size ranged from 1700 [25] to 875 [29]. The studies were conducted between 2013 and 2020 across the country.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Treatment seeking delay and associated factors among tuberculosis patients attending health facility in Ethiopia from 2000 to 2020: A systematic review and meta analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Therefore BALF levels of sCD14, IL-17 and IL-22 may be used as triage biomarkers to not only refer patients with low levels to conduct lung biopsy, but also refer patients with moderate BALF levels to start anti-TB therapy immediately. Delays in treatment initiation may lead to worse clinical outcomes and increased transmission [32,33]. Empiric antibacterial therapy was the major cause of anti-TB delay in this study.…”

Section: Discussionmentioning

confidence: 76%

Soluble CD14 and Th 17-Related Interleukins in Bronchoalveolar Lavage Fluid are Potential Triage Biomarkers for Pulmonary Tuberculosis

Liu¹,

Li²,

Dong³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Soluble CD14 (sCD14) and T helper 17-related interleukins (IL-17 and IL-22) in bronchoalveolar lavage fluid (BALF) are preliminarily reported to be increased in pulmonary tuberculosis (PTB). Their significances to the bacteriological confirmation and activity differentiation of PTB, however, are not completely clarified. Methods: A observational study was conducted in 154 consecutive adult patients who were primarily diagnosed with PTB based on radiographic abnormalities. Bacteriological confirmation was made using sputum/BALF smearing, TB-DNA, Xpert test and Mycobacterium tuberculosis (Mtb) culture. BALF and serum sCD14, IL-17 and IL-22 were measured using ELISA assays. Their associations with clinical/bacteriological characteristics were analyzed. Results: Finally, 103, 16, 7 and 28 patients were diagnosed with active, inactive, gray zone and non-PTB, respectively. Among active PTB patients, 82 (79.6%) cases, 33 (32.0%) based on sputum and additional 49 (47.6%) depended on BALF were bacteriologically confirmed. BALF levels of sCD14, IL-17 and IL-22 were similar between patients with PTB and non-PTB, but significantly higher in active PTB and bacteriologically-confirmed patients. The BALF levels of these biomarkers to some extent predicted bacteriological confirmation failure (AUC of IL-22 = 0.866), nonresponders to empiric antibacterial therapy, Xpert test (AUC of IL-22 = 0.760) and Mtb cultures. When the sensitivities were set at ³ 90% (WHO's minimal requirement for a triage test), the specificities of bacteriological confirmation failure prediction and empiric antibacterial therapy nonresponder prediction in interferon-g release assay-positive patients were about 67%, very close to the WHO's minimal requirement (³ 70%) for a triage test. In addition, serum levels of sCD14, IL-17 and IL-22 were relatively lower and had no predictive values. Conclusions: BALF levels of sCD14, IL-17 and IL-22, superior to their serum levels, are potential triage biomarkers and may be used to replace the expensive Xpert test in particular occasions or refer proper patients to conduct lung biopsy and expensive molecular tests in the first week or to start nondelayed anti-TB therapy bypassing empiric antibacterial therapy and time-consuming Mtb culture.

show abstract

“…The data for each of the five associated factors were exported to Stata SE version 14 after extracting data on excel spreadsheet. Ten studies (7,9,10,35,(48)(49)(50)(51)(52)(53) assessed associated factors including patients socio-demographic characteristics, clinical characteristics, and diagnostic modalities. Six studies analyzed the relationship between sex and health system delay; four studies assess distance to the health facility with health system delay.…”

Section: Factors Associated With Health System Delaymentioning

confidence: 99%

Health system delay in the treatment of tuberculosis patients in Ethiopia: a systematic review and meta-analysis

Tegegne

Wagnew

Belay

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Delay in diagnosis and initiation of effective treatment associated with increase in morbidity, mortality and on-going person-to-person transmission in the community at large. In Ethiopia, several studies have been conducted regarding health system delay among tuberculosis patients. However, studies assessing the health system delay in treatment of tuberculosis patients in Ethiopia had inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. Methods: We systematically searched from different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus and Springer link databases for studies published from June 6, 1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. Heterogeneity was evaluated using I squared statistic. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using random-effects model in R version 4.0.3 software(for median estimation) and Stata version 14 (for metan). The pooled estimates with 95% confidence intervals (CI) were presented using forest plots. Results: A total of 14 studies which comprising 6161 patients satisfying a priori set criteria were included. Our meta-analysis showed that, the estimated pooled median time of the health system delay was 15.29(95%CI: 9.94–20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015 the pooled median health system delay was 21.63(95% CI: 14.38-28.88) days, whereas studies conducted after 2015 the pooled median time of 9.33(95% CI: 3.95-14.70) days. Living in rural area (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. Conclusions: In Ethiopia, patients are delayed more-than two weeks in the treatment of tuberculosis. Being from rural residence was more likely to lead prolonged health system delay. Implementing efforts by targeting rural residence may help to shorten the health system delay and important implications for the success of tuberculosis control.

show abstract

Factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia

Cited by 12 publications

References 30 publications

Treatment seeking delay and associated factors among tuberculosis patients attending health facility in Ethiopia from 2000 to 2020: A systematic review and meta analysis

Treatment seeking delay and associated factors among tuberculosis patients attending health facility in Ethiopia from 2000 to 2020: A systematic review and meta analysis

Soluble CD14 and Th 17-Related Interleukins in Bronchoalveolar Lavage Fluid are Potential Triage Biomarkers for Pulmonary Tuberculosis

Health system delay in the treatment of tuberculosis patients in Ethiopia: a systematic review and meta-analysis

Contact Info

Product

Resources

About