Is depression associated with pathways to care and diagnosis delay in people with tuberculosis in Ethiopia?

Abstract

Background.Co-morbid depression is common in people with tuberculosis (TB). Symptoms of depression (low energy, impaired concentration, decreased motivation and hopelessness) may affect help-seeking; however, this impact has not been studied so far. The objectives of this study were to assess the impact of co-morbid depression on diagnostic delay, pathways to care, and to identify if it mediates other factors associated with diagnostic delay.Methods.We analyzed cross-sectional data collected from 592 adults with newly diagnosed TB. We assessed probable depression using Patient Health Questionnaire, nine items (PHQ-9) at a cut-off 10. Data on diagnosis delay, pathways to TB care, socio-demographic variables, stigma, types of TB, substance use, co-morbid chronic illnesses, and perception about TB were assessed using a structured questionnaire. Generalized structural equation modelling was used to analyze the data.Results.A total of 313 (52.9%) participants had probable depression. Pathway to TB care was direct for 512 (86.5%) of the participants and indirect for 80 (13.5%) of them. The median diagnosis delay was 12.0 weeks. Depression did not have a statistically significant association with pathways to TB care (β = −0.45; 95% CI−1.85 to 0.96) or diagnostic delay [adjusted odds ratio (AOR) = 0.90; 0.77–1.06]. Indirect pathway to TB care was positively associated with diagnosis delay (AOR = 2.72; 95% CI 1.25–5.91).Conclusions.People with TB who had co-morbid probable depression visited the modern health care as directly as and as soon as those without co-morbid depression. How socio-demographic factors influence pathways to care and diagnosis delay require qualitative exploration.

Magnitude and determinants of delay in diagnosis of tuberculosis patients in Ethiopia: a systematic review and meta-analysis: 2020

“…A total of 16 studies with a sample size of 6948 were included to determine the pooled prevalence of diagnostic delay of tuberculosis patients in Ethiopia. Of these studies five of them were conducted in the Amhara regional state [ 38 – 42 ] and three of them in the Oromia regional state [ 43 – 45 ]. Another of two studies were conducted in SNNPE [ 42 , 46 ] one in Tigrai regional state [ 47 ], one in Harari Regional state [ 48 ], One in Somali regional state [ 49 ], one study in Addis Ababa city administration, one study conducted in two regions of the country and one in Afar regional state [ 50 ] (Fig.…”

“…Patients with extra-pulmonary TB are 2.27 more likely to delay diagnosis of tuberculosis when compared with patients with pulmonary TB at (OR = 2.27, CI: 1.77, 2.91). Four studies out of 16 studies were included to look association between type of TB and delay in diagnosis [ 38 , 39 , 42 , 50 ]. All studies were significantly associated independently (Fig.…”

“…Four studies were included to compute the association between marital status and delay in the diagnosis of tuberculosis for the final meta-analysis [ 39 , 41 , 42 , 48 ]. A random-effect model was used to estimate the pooled association between marital status and delay in diagnosis of tuberculosis (I 2 44.1%, P = value <0.147).…”

“…A random-effect model was used to estimate the pooled association between marital status and delay in diagnosis of tuberculosis (I 2 44.1%, P = value <0.147). Among included studies, three of them have significant association with delay in diagnosis of TB [ 41 , 42 , 48 ] while one of the included did not have significant association [ 39 ]. The pooled result of the analysis indicates that unmarried individuals were 1.91 more likely to delay the diagnosis of tuberculosis (OR = 1.91, CI: 1.41, 2.59) (Fig.…”

“…Four studies were utilized to analyze association between HIV Sero- status and Delay in the diagnosis of TB [ 39 , 40 , 42 , 48 ]. The pooled indicates that the odds of not delaying TB diagnosis is 88% more likely for people living positively when compared with their counterparts 95% (OR = 0.12, CI: 0.09, 0.15) (Fig.…”