Patient delay in seeking tuberculosis diagnosis and associated factors in Hadiya Zone, Southern Ethiopia

Fuge, Terefe Gone; Bawore, Solomon Gebre; Solomon, Deneke Wolde; Hegana, Tadele Yohannes

doi:10.1186/s13104-018-3215-y

Cited by 25 publications

(42 citation statements)

References 18 publications

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“…Compared to delay studies conducted in Ethiopia, we report shorter patient delay of 31 days from northern Ethiopia [41], 30 days reported from Hadiya zone in southern Ethiopia [36], 60 days in Addis Ababa [35] and more than 2 months pretreatment duration from Sidama in southern Ethiopia [42], but longer than study from southern Ethiopia that reported 4 days [43]. There is much reduction in the overall delay as a result of increased coverage of health service, better awareness, difference in the study period and changes in socioeconomic conditions.…”

Section: Discussioncontrasting

confidence: 70%

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

Datiko¹,

Jerene²,

Suarez

2020

BMC Public Health

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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.

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Section: Discussioncontrasting

confidence: 70%

“…Studies from Ethiopia reported delays to be associated with educational status, poverty, awareness about TB and accessibility of TB services [35,36] with higher proportion of health system delay from northern Ethiopia [37]. However, most studies were limited to specific population groups and quantitative designs.…”

Section: Introductionmentioning

confidence: 99%

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

Datiko¹,

Jerene²,

Suarez

2020

BMC Public Health

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“… 30 At the individual level factors influencing total delay includes socioeconomic status, educational level, and cultural background. 31 In our study, the peak of female cases appeared later than that of male cases, which may be explained by the significantly longer total delay of female cases than male cases in developing countries. 32 The availability of health services also has an impact on diagnosis delay.…”

Section: Discussionmentioning

confidence: 45%

Seasonal variation in notified tuberculosis cases from 2014 to 2018 in eastern China

Zhu

Lü

et al. 2020

J Int Med Res

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Objective Tuberculosis (TB) incidence shows a seasonal trend. The purpose of this study was to explore seasonal trends in TB cases in Jiangsu Province. Methods TB case data were collected from the TB registration system from 2014 to 2018. The X12-ARIMA model was used to adjust the Jiangsu TB time series. Analysis of variance was used to compare TB seasonal amplitude (SA) between subgroups and identify factors responsible for seasonal variation. Results The TB incidence in Jiangsu showed a seasonal trend. Confirmed active TB peaked in March and reached a minimum in February. The amplitude of the peak-to-bottom difference was 38.15%. The SAs in individuals 7 to 17 years old (80.00%) and students (71.80%) were significantly different than those in other subgroups. Among bacterial culture positive individuals, the SAs among female patients, individuals aged 7 to 17 years and students were significantly different from those in the reference group. Among culture-negative patients, the SA among individuals aged 7 to 17 years was significantly different those in other subgroups. Conclusions The TB incidence in Jiangsu Province displayed a seasonal trend. Factors related to seasonal variation were age and occupation. Our results highlight the importance of controlling Mycobacterium tuberculosis transmission during winter.

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“…To compare with similar studies in SEA countries, proportions of delayed careseeking among patients were 34.1% in Myanmar migrant populations in Thailand, 67.4% in Nepal, 29% in South India and 75.3% in East Malaysia. These percentages of patient care-seeking delay differed because they depended on socio-economic status, awareness of the patients, receiving information on TB for prevention and treatment and availability of health care facilities [26][27][28][29]. The national TB control program should consider introducing aggressive active casefinding mechanisms among targeted high risk populations.…”

Section: Discussionmentioning

confidence: 99%

Delayed care-seeking and its underlying factors among patients with tuberculosis in Yangon, Myanmar

Tun

et al. 2020

J Infect Dev Ctries

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Introduction: Tuberculosis (TB) remains a major public health problem in Myanmar. Early care-seeking behaviors play a significant role in reducing TB transmission and speeding recovery. This study was conducted to estimate the proportion of patients with TB who delayed care-seeking and to identify underlying factors. Methodology: The study population included patients with TB treated in a TB diagnostic center in April 2015. A total of 346 patients were chosen as eligible respondents. The data were collected using structured questionnaires and face-to-face interviews. In addition to descriptive statistics, chi-squared test and multiple logistic regression were performed to show any associations. Results: The study revealed that 66.8% of patients delayed care-seeking, and the average duration of delay was 21 days. Using the chi-squared test, factors such as education, occupation, family income, knowledge of TB, possessing information about TB, having a family member or close friend contract TB, travel distance, and cost causing a burden were significantly associated with delayed care-seeking (p < 0.05). Multiple logistic regression analysis found that 4 variables exhibited significant associations: low levels of education, occupation as government staff member, possessing information about TB, and having a family member or close friend contract TB (p < 0.05). Conclusion: The results from this study provide useful comprehensive information addressing underlying factors associated with delayed care-seeking behaviors. These can be used to advance health education interventions regarding TB and strengthen early diagnosis of TB within community settings.

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Patient delay in seeking tuberculosis diagnosis and associated factors in Hadiya Zone, Southern Ethiopia

Cited by 25 publications

References 18 publications

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

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

Seasonal variation in notified tuberculosis cases from 2014 to 2018 in eastern China

Delayed care-seeking and its underlying factors among patients with tuberculosis in Yangon, Myanmar

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