Treatment seeking delay and associated factors among tuberculosis patients attending health facility in Ethiopia from 2000 to 2020: A systematic review and meta analysis

Abstract

Background Treatment seeking delay is defined as the time interval between the onset of the major symptoms of tuberculosis (TB) and the first visit to the formal health care facility. The patient was said to be delayed if the patient visited the health-facility after 3 weeks onset of major symptoms. However, in low-income countries like Ethiopia, the delay in treatment-seeking among tuberculosis patients contributes to a widespread transmission and high prevalence of tuberculosis. Methods Studies were retrieved from PubMed, Cochrane Database, Cinahl, Scopus, Mednar, and Google Scholar by employing a combination of search terms with Boolean operators. Heterogeneity across studies was assessed using the Cochrane Q test. A funnel plot was used for visual assessment of publication bias. Subgroup analyses were performed to explore the possible causes of heterogeneity. Egger’s weighted regression test at a p-value < 0.05 was used to assess the presence of publication bias. Sensitivity analysis was performed to judge whether the pooled effect size was influenced by individual study. STATA software version 14 was used for all statistical analyses. Result A total of 12 studies with 5122 total sample size were included. The national pooled prevalence of treatment seeking delay was 44.29% (95% CI: 39.805, 48.771). The visual inspection of the funnel plot showed the asymmetrical distribution, and the Egger test showed insignificant (P = 0.348). Patients who did not seek formal health care providers on a first contact had about 7 times more likely to delay than patients who sought formal health care provider on a first contact (OR: 7.192 ((95% CI 5.587–9.257), P = 0.001, I2: 85%). The others independent predictors of delay were rural residence (OR: 3.459 ((95% CI 1.469–8.148), P ≤ 0.001), extra pulmonary TB (OR: 2.520 ((95% CI 1.761–3.605), 0.180), lower educational level (OR 11.720 ((95% CI 1.006–2.938), P <0.001), and distance more than 10km from health facility (OR: 1.631 ((95% CI (10.858–3.101), P = 0.001). Conclusion In this review, we identified a substantial treatment seeking delay among TB patients in Ethiopia. And, the independent predictors of delay were treatment sought before formal health care provider, residence of the patient, type of TB, educational level, and distance from a health facility. Thus, we recommend health extension workers, health professionals and other stakeholders to focus on patient education, and to continuously mobilize the whole communities on early treatment seeking with a special emphasis given to where treatment sought before formal health care provider, rural resident, extra pulmonary TB, and a patient living farther than 10km distance from health facility.

Willingness to seek medical care for tuberculosis and associated factors among the elderly population in Shenzhen: a cross-sectional study

“…Therefore, measures should be taken to improve TB-related attitudes and behaviours among the elderly, which may help to increase willingness to seek medical care for TB. Intriguingly, we found that TB knowledge scores were not a significant determinant of willingness to seek medical care in the multivariate analysis, which was not in line with previous studies 9 25 26 32 39. Therefore, the association between TB knowledge and willingness to seek medical care needs further research.…”

“…[23][24][25] In addition, unwillingness to seek medical care may increase the potential risk of transmission and will have a negative impact on their families and society. 26 Our findings showed that the main reason for being unwilling to seek medical care for TB was 'long treatment cycle and heavy economic burden'. This indicated that individuals' economic situation impacts their willingness to seek treatment.…”

“… 23–25 In addition, unwillingness to seek medical care may increase the potential risk of transmission and will have a negative impact on their families and society. 26 …”

“…Individuals with possible TB symptoms who do not seek medical care will miss the opportunity for early detection of TB, leading to delayed treatment and poor prognoses 23–25. In addition, unwillingness to seek medical care may increase the potential risk of transmission and will have a negative impact on their families and society 26…”

Knowledge of symptoms and delays in diagnosis of extrapulmonary tuberculosis patients in North Shewa zone, Ethiopia

“…Despite the advance in diagnosis and expansion of TB services, patients’ poor health-seeking behaviour and diagnostic delay of EPTB cases remained problematic in Ethiopia and the case-detection efforts are unsuccessful and TB is very widespread in the country [ 18 , 19 ]. Many community-based studies reported that the number of undetected EPTB cases in communities can be greater than the number of notified cases [ 20 , 21 ].…”