Total Delay in Treatment of Tuberculosis and Associated Factors among New Pulmonary TB Patients in Selected Health Facilities of Gedeo Zone, Southern Ethiopia, 2017/18

Abstract

Background. TB is an infectious disease caused by the bacillus Mycobacterium TB complex. It is a major public health concern causing devastating illness in millions of people each year and one of the top 10 causes of death worldwide following HIV pandemic. It demands huge costs each year for prevention, diagnosis, and treatment of TB. Global TB control progress depends on major advances in early diagnosis and treatment. Despite progress in providing diagnosis and preventive treatment of TB, big detection and treatment gaps remained with delayed diagnosis and treatment of TB especially in resource-limited countries. This is mainly because of factors related to the patient and health care system including sociodemographic, economic, and cultural barriers to accessing TB care. Objective. The study conducted in Gedeo Zone, Southern Ethiopia, had the primary purpose of identifying the median delay in starting a correct TB treatment and the associated factors for such a delay in patients newly diagnosed with PTB in selected health facilities of Gedeo Zone, Southern Ethiopia, 2017/18. Methods. Institutional based cross-sectional study was conducted among new pulmonary TB patients in selected health institution of Gedeo Zone, Southern Ethiopia, 2017, from October, 2017, to May, 2018. All new pulmonary TB patients who fulfill the inclusion criteria during the study period were included in the study after informed consent was obtained from the participants. Data was cleaned, coded, and entered into SPSS version 20 for analysis. A frequency for variables was calculated. Chi-square was used to screen the possible potential associated factors and multivariate analysis was used to ascertain the association between variables. All statistical tests values of p<0.05 were considered as statistically significant. Result. The median total in treatment of TB was 60 days. Among the total study participants, 50.9% of the participants have unacceptable/longer total delay in TB treatment. Being of female gender, not attending formal education, having rural residency, having poor knowledge of TB, having home distance >10Km from the nearest health facility, visiting nonformal health care provider, and taking antibiotic treatment before TB diagnosis empirically were identified as significant independently associated factors for unacceptable total treatment in TB. Conclusions. There was higher median total delay in treatment of TB (60 days) and an overall prevalence of 50.9% unacceptable/longer total delay in treatment of TB. Female gender, rural residence, not attending formal education, visiting nonformal health facility as first health care seeking, having poor knowledge of TB, and having antibiotic treatment before TB diagnosis were identified as independent significant associated factors.

Factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia

“…The median patient and health system delays in the current study were similar with previous findings reported in Ethiopia [ 9 , 17 ] and Africa [ 24 , 25 ]. However, the median patient delay was shorter than previous studies in Ethiopia [ 16 , 26 , 27 ] and longer than other reports from Ethiopia [ 28 , 29 ] and African [ 3 , 30 ] but the health system delay was shorter than studies in Ethiopia [ 13 , 14 ] which have similar median patient delay with this study. The reason for the shorter delay might be related to while two of the previous studies [ 16 , 29 ] were done in pastoralist communities; the current study was done in the agrarian community having relatively better accessibility and knowledge about TB compared to the pastoralist community.…”

“…Rural residents had higher odds of patient delay compared to the urban residents in health-seeking which was supported by studies done in Ethiopia [ 27 , 31 , 32 ], and Mediterranean region [ 7 ]. This might be related to the poor access of rural residents to health information and health facilities compared to the urban residents.…”

Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South India

“…8 Many studies have been conducted both globally [9][10][11][12][13][14] and in the Indian context [15][16][17][18][19][20] to better understand TB patient care-seeking pathways. These studies find a number of factors to be commonly associated with delayed care-seeking, including lack of knowledge about TB, [10][11][12][13] being a woman, 11 14 20 lack of education, 11 living far from health facilities, 11 12 15 20 visiting informal care providers, 11 13 low income in Africa and Asia, 14 20 high income in South India, 16 age, 9 10 13 19 and tobacco and alcohol use. 16 21-25 Although existing research provides some insight into what drives people to seek care for their TB symptoms, these studies often only focus on a limited set of potential drivers, many of which are demographic variables.…”

<p>Geographic Accessibility, Readiness, and Barriers of Health Facilities to Offer Tuberculosis Services in East Gojjam Zone, Ethiopia: A Convergent Parallel Design</p>

“…13 Based on a recent data, the TB incidence in Ethiopia is estimated at 80 -172/100,000 population, 1,14,15 .About 60,000 TB cases are not yet detected in the country, 15,16 and the national TB case notificateion rate and treatment success rate were reported to be 56% and 84%, respectively. 17,18 The low TB case notification rate may be linked to use of poor TB incidence estimation methods, 16,19 relying only on passive case detection approach to identify TB cases, 8,20,21 lack of adequate TB dignostic tools, 8,20,22 poor service availability and readiness, 8,21,23 high patient and facility delay, [24][25][26] and poor community awareness about TB . 14,18,27,28 The burdens of TB could be preventable under effective preventive strategies, early diagnosis and appropriate treatment.…”