<p>Longer Delays in Diagnosis and Treatment of Pulmonary Tuberculosis in Pastoralist Setting, Eastern Ethiopia</p>

Abstract

This study aimed to assess the extent of patient, health system and total delays in diagnosis and treatment of pulmonary tuberculosis (TB) in Somali pastoralist setting, Ethiopia. Patients and Methods: A cross-sectional study among 444 confirmed new pulmonary TB patients aged ≥15 years in 5 TB care units was conducted between December 2017 and October 2018. Data were collected using a structured questionnaire and record review. We measured delays from symptom onset to provider visit, provider visit to diagnosis and diagnosis to treatment initiation. Delays were summarized using median days. Mann-Whitney and Kruskal-Wallis tests were used to compare delays between categories of explanatory variables. The Log-binomial regression model was used to reveal factors associated with health system delay ≥15 days, presented in adjusted prevalence ratio (APR) with 95% confidence interval (CI). Results: The median age of patients was 30 years, ranged from 15 to 82. The majority (62.4%) were male, and nearly half (46.4%) were pastoralists. The median patient, health system and total delays were 30 (19-48.5), 14 (4.5-29.5) and 50 (35-73.5) days, respectively. The median patient delay (35.5 days) and total delay (58.5 days) among pastoralists were substantially higher than the equivalent delays among non-pastoralists [p<0.001]. Of all, 3.8% of patients (16 of 18 were pastoralists) delayed longer than 6 months without initiating treatment. Factors associated with health system delay ≥15 days were mild symptoms [APR (95% CI) = 1.4 (1.1-1.7)], smear-negativity [APR (95% CI) = 1.2 (1.01-1.5)], first visit to health centers [APR (95% CI) = 1.6 (1.3-2.0)] and multiple provider contacts [APR (95% CI) = 5.8 (3.5-9.6)]. Conclusion: Delay in diagnosis and treatment remains a major challenge of tuberculosis control targets in pastoralist settings of Ethiopia. Efforts to expand services tailored to transhumance patterns and diagnostic capacity of primary healthcare units need to be prioritized.

Impact of early chest radiography on delay in pulmonary tuberculosis case notification in Ethiopia

“…The median patients’ delay of our current study was longer when compared with studies done in Ethiopia, at a national level that reported 21 days, [ 5 ] 17 days at Addis Ababa, [ 18 ] and 25 days in southwestern Ethiopia [ 24 ] but comparable with studies in the country that reported a median of patients’ delay 30 days at Adama, central Ethiopia, [ 28 ] at Gamo zone, south Ethiopia, [ 29 ] and Somali region, eastern Ethiopia. [ 30 ] The difference might be due to the accessibility to health facilities, socioeconomic factors, and study populations. Besides, the patients’ delay was longer among rural residents.…”

“…This could be related to the costs of transportation, accommodation, and others such as child care at home. [ 28 , 30 ] Patients’ delay was low among ART patients. This could be due to the existing integrated program to control the TB/HIV co-infection that initiated the screening and diagnosis at an early stage.…”

Tuberculosis Knowledge and Delayed Health Care Seeking Among New Diagnosed Tuberculosis Patients in Primary Health Facilities in an Urban District, South Africa

“…4 Early diagnoses and treatment are key elements of successful TB control; however, a major challenge of TB control and prevention programs is a delay in seeking health care. 5,6…”

“…Identifying the individual and community related factors that lead to delayed TB diagnosis and treatment is essential to evaluate the effectiveness of TB control programs to develop interventions to reduce TB transmission in communities. 6 Furthermore, understanding the health-seeking behavior of patients with symptoms suggestive of TB is important to design national responses to improve TB services in health facilities. 1…”

“…4 Early diagnoses and treatment are key elements of successful TB control; however, a major challenge of TB control and prevention programs is a delay in seeking health care. 5,6 Systematic reviews on studies conducted in low middle income countries identified a wide range of factors affecting delay in the diagnosis and treatment of TB that were related to individual, socio-demographic, economic, and health system factors, as well as clinical characteristics. 7,8 In addition, the belief that TB is always associated with HIV and stigma contribute to delayed diagnosing and treatment-seeking.…”