Time Interval for Diagnosis of Tuberculosis and Related Expenditure in Selected Health Centers in Addis Ababa, Ethiopia

Abstract

Background. Tuberculosis (TB) has continued to be a major health problem globally, in spite of the efforts to improve the diagnosis, treatment, and prevention. It affects millions of people each year and stands as the second cause of death due to infectious disease in the world. Early case finding and timely initiation of treatment is essential to ensure effective control of the disease as late diagnosis and treatment can aggravate the disease and result in poor outcomes and increase chances of transmission. Although TB services are supposed to be provided free of charge, TB affected families incur different types of costs in the process of seeking care, which might include health and nonhealth related costs. TB programs need to identify the underlying factors for delay and related expenditure for TB related services, in order to devise an effective strategy to reduce them. Therefore, the study aimed to assess the time interval between developing TB symptom until patients start anti-TB treatment and associated cost incurred by patients and families. Methods. This cross-sectional study was conducted among pulmonary TB patients who are bacteriologically confirmed, whose age is above 15 years and diagnosed at health centres in Addis Ababa. Results. The median time interval between onset of symptom and commencement of treatment was 4 weeks (IQR: 3, 6). Most patients with TB symptoms visited several health facilities before the final diagnosis was confirmed, the median number of visits being two, and only 48.8% were diagnosed on their first visit. Hence, they spent a lot of their limited resource in search of getting the right diagnosis. The total combined expenditure for all the visits was estimated to be median (IQR) 172.65 birrs (12, 671). Two variables were found to show statistically significant association with higher expenditure. Respondents who have good level of knowledge about TB are less likely to spend more than the median expenditure almost by a fifth compared to those with limited knowledge on TB, (adjusted odds ratio (AOR) = 0.2, with 95% confidence interval (CI): 0.06, 0.84). Patients who visited public hospitals were almost three times and those who visited private health facilities almost four times more likely to pay more than the median total expenditure, compared to those who visited health centre, AOR (95% CI) = 2.8 (1.53, 5.19) and AOR (CI) of 3.86 (1.06, 14.03), respectively. Conclusion. Patients with TB symptoms visit several health facilities till they are diagnosed, the median duration from onset of symptom till commencement of TB treatment being 4 weeks. It was noted that they face major expenses in the process of navigation to the right care. Two variables had statistically significant association with high pre-diagnosis expenditure, where patients with good level of knowledge about TB are less likely to spend more than the median, while patients who visited public hospitals or private health facilities had very high expenses. Improved public awareness about TB, minimizing service charges and other related fees, and further improvement in increasing access to services could reduce the length of time and expense for TB patients and their families. It is recommended to build capacity of health service providers to update them on programmatic approaches and latest diagnostic algorithm. It is important to strengthen public private partnership for TB services.

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

“…Delay in the diagnosis of TB endured obstacles in Ethiopia, [ 5 ] and health facility-driven delays were frequent among smear-negative, first sought health care, and among rural. [ 5 , 18 , 19 ] A previous study showed that many patients visited several health facilities up to four rounds with a median of two before getting their final TB diagnosis [ 20 ] and there have been many challenges that contribute to the low case-finding status of the country. [ 21 , 22 ] However, evidence and recommendations on how to mitigate the delays are limited.…”

Challenges to paediatric tuberculosis care as perceived by health workers in Kano, North-western Nigeria

“…Adamu et al observed in their study in Kano that transportation and diagnostic out-of-pocket expenses may negatively affect the outcome of TB treatment. 4 This observation was not contrary to reports that medical expenses and other indirect costs in poverty situations are barriers to TB treatment and TB treatment initiation for individuals of all ages in Sub-Saharan Africa (SSA) by Sullivan et al , 16 Shimeles et al 15 Asres et al, 16 and Kirubi et al 17 Sullivan et al further reported, in their metaanalysis, that geography or distance to TB treatment centers (infrastructure barriers) contributed to delayed access and poor treatment outcomes. 6 The inability of children to cough up sputum was perceived as a challenge to paediatric TB care by 95.4% of health workers interviewed.…”

Mycobacterium Bovis Characterization through RD4 Deletion and Spoligotyping Techniques

“…to BTB [74]. This the variations in prevalence could be due to the possible difference in the epidemiology of the disease in the animal populations, markets sources of animal (from which they brought to abattoirs either from high BTB prevalent or their local BTB burden), body condition score of the animals and types of production system; The intensive livestock management system could contribute the development of mycobacterial infections than the extensive livestock management system [75][76][77][78]. Based on the postmortem inspection, the prevalence of TB lesions showed marked variation between the two abattoirs; the cases recorded in cattle slaughtered in Hawassa university abattoir was higher, 8.1% (31/384) than Hawassa municipal abattoir, 3.5% (13/369).…”