Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study

Abstract

Background: Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia. Methods: This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay. Results: Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10-45), 4 (2-10) and 2 (1-3) days respectively. The median (IQR) of total delay was 33 (19-67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. Poverty, cost of seeking care, protracted diagnostic and treatment initiation, inadequate community based TB care and lack of awareness were associated with delay. Community health workers reported that lack of awareness and the expectation that symptoms would resolve by themselves were the main reasons for delay. Conclusion: TB patients' delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia.

Drivers of respiratory healthcare demand in Acre state, Brazilian Amazon: a cross-sectional study

“…These two papers imply that subjective misevaluation of disease severity, which may be related with the level of pain experienced, affects care seeking. InTetteh et al (2017), the subjective value of administration mode, of dosing, of risk of adverse events and of the interruption of daily routine, were shown to in uence demand for medication.Objective factors such as gender, income and access to health facilities were also found by other studies to be insigni cant predictors(Seid and Metaferia, 2018, Tetteh et al, 2017, Datiko et al, 2020, Diaz et al, 2013. Notwithstanding, education is generally found to be relevant (Tetteh et al, 2017, Seid and Metaferia, 2018) but it is not fully correlated with health literacy (i.e., the capacity to recognize symptoms and illness and to make decisions to prevent or manage them) which may be a stronger force behind healthcare demand(Suka et al, 2016).5.2 Other factors not controlled for and policy implicationsSome words are merited on the macroeconomic factors that were not directly controlled for.…”

“…A recent large international survey, conducted by Velden et al (2020), with 5,196 individuals from seven developed and seven developing countries including Brazil, estimated that only 30% of patients with sore throat, a symptom associated with In uenza-like illnesses and acute respiratory illnesses (Zhang et al, 2020), seek a general practitioner. Similarly high rates of refusal and also delay in seeking care were found in national-level surveys (Datiko et al, 2020, Seid and Metaferia, 2018, Zhang et al, 2020, Suka et al, 2016. These behaviours besides prolonging the impairment of own health and labour productivity (Piabuo and Tieguhong, 2017), and increasing risk of own mortality, which already have social consequences, may also increase contagion locally in case of viral and bacterial diseases (Datiko et al, 2020, Seid andMetaferia, 2018).…”

Increase in Tuberculosis Diagnostic Delay during First Wave of the COVID-19 Pandemic: Data from an Italian Infectious Disease Referral Hospital

“…A preliminary analysis on the HSD comparing the two periods found that there was, on average, an increase of 1 day. Although this increase was statistically significant, we did not consider this delay as clinically significant; we, thus, evaluated only characteristics potentially associated with a long PD, (>30 days) [36], using logistic regression models both univariate and multivariate, with backward selection (p = 0.20). The data were analyzed using Stata software, release 15.0.…”

“…We also evaluated total diagnostic delay (TD) as the time interval between the onset of symptoms and start of TB treatment. This included patient delay (PD) and health system delay (HSD); PD: period from the onset of the first symptom(s) related to pulmonary TB to the first medical consultation; HSD: the time interval between the first medical consultation and start of TB treatment [35,36].…”

Economic costs of accessing tuberculosis (TB) diagnostic services in Malawi: an analysis of patient costs from a randomised controlled trial of computer-aided chest x-ray interpretation

“…Ensuring early diagnosis and prompt initiation of treatment can reduce TB transmission and improve individual health outcomes whilst reducing disability [2][3][4][5] . However, the effectiveness of TB diagnostic interventions in health systems are limited as poverty and high out of pocket expenditure are barriers to patients seeking TB diagnosis and treatment in LMICs [6][7][8] .…”