Delay for First Consultation and Its Associated Factors among New Pulmonary Tuberculosis Patients of Central Nepal

Abstract

Tuberculosis (TB) is still a major public health challenge in Nepal and worldwide. Most transmissions occur between the onset of symptoms and the consultation with formal health care centers. This study aimed to determine the duration of delay for the first consultation and its associated factors with unacceptable delay among the new sputum pulmonary tuberculosis cases in the central development region of Nepal. An analytical cross-sectional study was conducted in the central development region of Nepal between January and May 2015. New pulmonary sputum positive tuberculosis patients were interviewed by using a structured questionnaire and their medical records were reviewed. Among a total of 374 patients, the magnitude of patient delay was 53.21% (95% CI: 48.12–58.28%) with a median delay of 32 days and an interquartile range of 11–70 days. The factors associated with unacceptable patient delay (duration ≥ 30 days) were residence in the rural area (adj. OR = 3.10, 95% CI: 1.10–8.72; p value = 0.032) and DOTS center located more than 5 km away from their residences (adj. OR = 5.53, 95% CI: 2.18–13.99; p value < 0.001). Unemployed patients were more likely to have patient delay (adj. OR = 7.79, 95% CI: 1.64–37.00; p value = 0.010) when controlled for other variables.

Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study

“…In addition, the DOTS strategy has been decentralized, making TB diagnostic and treatment services more accessible to the community. Increased health services accessibility reduces both patients’ [20, 21] and health system’s delays [5]. Despite the integration of TB screening activities in the general health care and increased access in TB diagnostic and treatment services however, it is surprising that the median health system’s delay observed in the current study is still similar with findings of former studies conducted in Amhara Region of Ethiopia [6, 12].…”

Patient Delay in Initiating Tuberculosis Treatment and Associated Factors in Oromia Special Zone, Amhara Region

“…Patients with undiagnosed pulmonary TB primarily act as reservoirs for transmission. The contagion parameter suggests that, where TB is endemic, each infectious case will result in 20-28 secondary infections [4].…”

“…The advances in TB prevention and control program lead to a decrease in mortality according to the Millennium Development Goals (MDG). In all, effective diagnosis and treatment of TB saved an estimated 43 million infectiousness, drug resistance, relapse, and even death due to TB [4,5].…”

“…The related literature has revealed that patients' first presentation to health facilities is associated with geographical condition, health service, being unemployed, distance, age, sex, poverty, educational status, rural resident, awareness of TB, self-treatment, and stigma [4][5][6]. Delay in the diagnosis and start of effective treatment of TB patients result in a prolonged period of infectivity in the community and health care workers.…”

“…Studies on different parts of the world showed that the magnitude or duration of patient delay was 53.2% in Nepal [4], 72% with greater than 30 days in Colombia [5], 34.8% with a median delay of 32 days in Turkey [7], 65.5% in Iran [9], and 61 and 30 days in Peruvian Amazon and Thailand [10,11], respectively. In the African region, patient delay, the time from onset of symptom to first consultation to modern health care, is alarmingly prolonged with studies reporting from 71% in Tanzania [12], 61% in Nigeria [13], and 48% in Zimbabwe [14], and also, some studies in Ethiopia showed that there was a patient delay of 62.3% in the North Wollo zone [15], 62% and 52.4% in Bahir Dar town, respectively [16,17], and 42% in Addis Ababa [18].…”