Patient and health system delay among patients with pulmonary tuberculosis in Beira city, Mozambique

Abstract

BackgroundTB control is based on the rapid identification of cases and their effective treatment. However, many studies have shown that there are important delays in diagnosis and treatment of patients with TB. The purpose of this study was to assess the prevalence of and identify risk factors associated with patient delay and health system delay among newly diagnosed patients with pulmonary TB.MethodsA cross sectional study was carried out in Beira city, Mozambique between September 2009 and February 2010. Patients in the first month of treatment were consecutively selected to this study if they had a diagnosis of pulmonary TB, had no history of previous TB treatment, and were 18 years or older and provided informed consent. Data was obtained through a questionnaire administered to the patients and from patients’ files.ResultsAmong the 622 patients included in the study the median age was 32 years (interquartile range, 26–40) and 272 (43.7%) were females. The median total delay, patient delay and health system delay was 150 days (interquartile range, 91–240), 61 days (28–113) and 62 days (37–120), respectively. The contribution of patient delay and health system delay to total delay was similar. Farming, visiting first a traditional healer, low TB knowledge and coexistence of a chronic disease were associated with increased patient delay. More than two visits to a health facility, farming and coexistence of a chronic disease were associated with increased health system delay.ConclusionsThis study revealed a long total delay with a similar contribution of patient delay and health system delay. To reduce the total delay in this setting we need a combination of interventions to encourage patients to seek appropriate health care earlier and to expedite TB diagnosis within the health care system.

Delay in Tuberculosis Diagnosis among Tuberculosis Patients at the Three Hospitals: Asella, Robe and Abomsa of Arsi Zone, Oromia Regional State, March, 2015

“…The highest median health system delay reported in the reviewed studies was 62 days from Mozambique [16] and the lowest was 6 days from Addis Ababa Ethiopia [15]. Health service delay is longer than patient delay in one study from northern Ethiopia magnifying the contribution of health system to diagnosis delay [6].…”

“…The Sub-Saharan studies reported median patient delay as high as 61 days in Mozambique [16], and as low as 14 days in South Africa and Malawi [17] [20]. 58% of Ugandan and 38% of Tanzanian TB patients delay for diagnosis greater than 4 weeks [26] [27].…”

Discursos sobre a terapia de curta duração para o controle da tuberculose

“…The imaginary subject formation is observed here, believing that the fact that the patient takes the medication in the first month under observation implies the certainty of compliance with the treatment. The actions of demanding medication intake, evaluating the patient and requesting the registration card are part of the literature practices on TB treatment and adherence (1,(12)(13) .…”

Delays in the Diagnosis and Treatment of Pulmonary Tuberculosis

“…Wandwalo et al (11) reported that the patient delay was significantly longer in rural areas and for patients with lower level of education. A study conducted in Mozambique indicated that farming and the coexistence of a chronic disease were associated with increased patient and health care system delays (14). It was reported that being aged 55-64 years was associated with longer patient delay and negative smear examination was associated with longer health care system delays (25).…”

“…It was reported that delays in tuberculosis diagnosis were associated with greater transmission of infection to contacts (9). Delays in the diagnosis and treatment of tuberculosis patients have been commonly reported in both developing and developed countries (10)(11)(12)(13)(14)(15)(16)(17)(18). The current study aimed to discuss the length of delays and possible reasons for delays in pulmonary tuberculosis patients.…”