Factors underlying diagnostic delay in tuberculosis patients in a rural area in Tanzania: a qualitative approach

Abstract

BackgroundDiagnostic delay in patients with tuberculosis (TB) leads to ongoing TB transmission, higher mortality rates and increased patient and government health expenditure. Qualitative research focussed on patients’ self-perceptions of disease and their care-seeking behaviour helps to guide health education programmes by providing us with the understanding of the knowledge, attitudes and practices that underlie diagnostic delay.Patients and methodsSemi-structured interviews with 28 recently diagnosed TB patients and four traditional healers were conducted. The interviews were audio-recorded and content analysis was performed.ResultsThe median total delay was 188 days. The health provider delay (31 days) was longer than the patient delay (21 days) and the health system delay (26 days). The health system delay was longest in patients not being diagnosed at their first hospital visit and subsequently visiting other health care providers, mostly traditional healers.ConclusionsA poor knowledge of TB signs and symptoms and patients’ beliefs about curses as the origin of diseases lead to delayed care-seeking at the hospital level in an area of North-Western Tanzania. Failure to identify TB cases by formal and non-formal health providers indicates that the education of both communities as well as health workers is essential in order to reduce diagnostic delays.

Delay in Diagnosis of Tuberculosis among Under Treatment Patients in Rajshahi City, Bangladesh

“…A qualitative approach at rural area of Tanzania did not found any patients being higher educated. 28 The result of present study was consistent with some other studies 5,7,29,30 as well. Economic barrier frequently causes obstruction for seeking health care facilities.…”

“…5,15,[23][24][25][26][27][28][29][30][31][32] In this study, the higher percentage of patients went to public hospital for seeking health care, but diagnostic delay were higher among those went to pharmacy at first for seeking health care before the diagnosis. A study in Ethiopia, patients who first visited a qualified medical provider experienced delay before initiation of diagnosis and treatment.…”

Análisis de la mortalidad por tuberculosis en la ciudad de Medellín, año 2012

“…Estas enfermedades concomitantes se han relacionado con el aumento de la mortalidad atribuible a la tuberculosis en otros estudios (13,14). Asimismo, el diagnóstico hospitalario se ha asociado a una presentación clínica en estadios más avanzados de la tuberculosis (15), lo que probablemente refleja una baja captación de sintomáticos respiratorios en el ámbito ambulatorio y la falta de reconocimiento de los signos de gravedad por parte de los pacientes y del grupo médico (16)(17)(18)(19).…”

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

“…5) such as unemployment, poor TB knowledge, and having difficulties or to travel a long distance to visit health facilities [39,47]. Long-distance to health facilities was also reported by qualitative studies as a barrier to care-seeking [44,109,110,112,115,124,129,134,135,138,140,143]. In addition to physical barriers, financial insecurities and economic challenges also compounded patient delay [21, 24, 29, 34-36, 39, 46, 47, 62, 63, 65, 68, 72, 73, 79, 81, 85, 86].…”