Delay in the diagnosis and treatment of pulmonary tuberculosis in Uzbekistan: a cross-sectional study

Abstract

BackgroundEarly diagnosis and prompt effective therapy are crucial for the prevention of tuberculosis (TB) transmission, particularly in regions with high levels of multi-drug resistant TB. This study aimed to evaluate the extent of delay in diagnosis and treatment of TB in Uzbekistan and identify associated risk factors.MethodsA cross-sectional study was performed on hospital patients with newly diagnosed TB. The time between the onset of respiratory symptoms and initiation of anti-TB treatment was assessed and delays were divided into patient, health system and total delays. Univariable and multivariable logistic regression analysis was used to evaluate determinants of diagnostic and treatment delay.ResultsAmong 538 patients enrolled, the median delay from onset of symptoms until treatment with anti-TB drugs was 50 days. Analysis of the factors affecting health-seeking behaviour and timely treatment showed the presence of the patient factor. Self-medication was the first health-seeking action for 231 (43%) patients and proved to be a significant predictor of delay (p = 0.005), as well as coughing (p = 0.009), loss of weight (p = 0.001), and visiting private and primary healthcare facilities (p = 0.03 and p = 0.02, respectively).ConclusionTB diagnostic and treatment delay was mainly contributed to by patient delay and should be reduced through increasing public awareness of TB symptoms and improving public health-seeking behaviour for timely initiation of anti-TB treatment. Efforts should be made to minimise irrational use of antibiotics and support interventions to restrict over-the-counter availability of antibiotics.

Factors Associated with Patient Delay in Scaphoid Nonunions

“…Based on related literature, potential relevant patient related factors were inquired. These subjective aspects included if patients had immediate post-injury pain symptoms [13], had the perception they suffered a wrist fracture after their injury [14], expected benefit from consulting a medical professional [15], if they felt to unnecessary burden the health care system if consulting a medical professional [16], had used self-treatment appliances [17] or had previous negative experiences at an emergency department [18]. In case of nonresponse, patients were contacted by telephone, and if required surveys were sent a second or third time.…”

Health care seeking behaviour of pulmonary tuberculosis patients in Jabalpur district, Madhya Pradesh

“…Self medication has also been identified as a major reason for delayed diagnosis of PTB from various studies. [10][11][12][13] The urban part of the sample was significantly more involved in practicing non prescribed medications as compared to rural part where practice of consulting a faith healer (guniya) was more prevalent (Table 2). Meanwhile, they would also seek care at a health care provider.…”

Analisis Perilaku dan Faktor Penyebab Perilaku Penggunaan Antibiotik Tanpa Resep di Surabaya

“…Selain tidak diperlukan, penggunaan antibiotik tanpa resep dokter juga berpotensi menyebabkan penundaan pemeriksaan diri ke dokter yang pada akhirnya akan menempatkan pasien pada risiko tertinggi mengalami kegagalan diagnosis kemungkinan adanya penyakit yang serius, seperti tuberculosis. 33 Hasil analisis deskriptif terkait faktor dominan yang menyebabkan perilaku penggunaan antibiotik tanpa resep menunjukkan domain "halhal yang mendorong" yang dalam penelitian ini meliputi pengalaman penggunaan antibiotik sebelumnya, perilaku peresepan dokter, dan akses untuk memperoleh antibiotik sebagai faktor utama penyebab perilaku tersebut. Pengalaman penggunaan antibiotik sebelumnya sebagai faktor dominan menentukan perilaku penggunaan antibiotik tanpa resep dokter juga ditemukan dalam penelitian Khan et al di India yang menunjukkan bahwa 56,50% pasien melakukan swamedikasi antibiotik karena telah menggunakan antibiotik sebelumnya.…”