Delay of Treatment among New Smear-Positive Pulmonary Tuberculosis Patients in Thai-Cambodia Border: Cases Study in Surin and Sisaket Province, Thailand

Butsorn, Aree; Suggaravetsiri, Pornnapa; Tesana, Nongluck

doi:10.3923/rjmsci.2010.340.345

Cited by 6 publications

(18 citation statements)

References 3 publications

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“…Long-distance to health facilities was also reported by qualitative studies as a barrier to care-seeking [ 48 , 111 , 112 , 114 , 117 , 126 , 131 , 136 , 137 , 140 , 142 , 145 ]. In addition to physical barriers, financial insecurities and economic challenges also compounded patient delay [ 20 , 25 , 28 , 33 , 38 – 40 , 43 , 50 , 51 , 66 , 67 , 69 , 72 , 76 , 77 , 83 , 87 , 88 ]. Among qualitative studies (Table 3 ), seven articles reflected on participant’s experiences where competing priorities of livelihoods and commitment to work and family led to individual care-seeking delay [ 48 , 125 – 127 , 134 , 138 , 145 ].…”

Section: Resultsmentioning

confidence: 99%

“…The inability of people with TB to recognize symptoms such as fever and cough that were not ascribed to TB intrinsically led to self-medication and treatment or waiting for symptoms to self-resolve due to low perceived disease severity [ 110 , 119 , 126 , 128 , 129 , 134 , 137 , 140 , 142 ]. Studies reported that the presence of cough [ 69 , 70 , 74 , 80 , 86 , 88 ] was associated with patient delay compared to hemoptysis and weight loss that were perceived to be more severe (Table 2 ). However, the relationships between TB symptoms and patient delay were not statistically significant in the meta-analysis (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis

et al. 2021

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Background Thirty countries with the highest tuberculosis (TB) burden bear 87% of the world’s TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the duration and determinants of delayed diagnosis and treatment of pulmonary TB in high TB-burden countries. Methods We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. We performed a narrative synthesis of the covariates significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. Results This review included 124 articles from 14 low- and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC). The pooled median duration of delays (in days) were—patient delay (LIC/LMIC: 28 (95% CI 20–30); UMIC: 10 (95% CI 10–20), health system delay (LIC/LMIC: 14 (95% CI 2–28); UMIC: 4 (95% CI 2–4), and treatment delay (LIC/LMIC: 14 (95% CI 3–84); UMIC: 0 (95% CI 0–1). There was consistent evidence that being female and rural residence was associated with longer patient delay. Patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Organizational and policy factors mediated health system and treatment delays. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high-burden countries. Conclusions This review presented the duration of delays and detailed the determinants of delayed TB diagnosis and treatment in high-burden countries. The gaps identified could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care. PROSPERO registration: CRD42018107237.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis

et al. 2021

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“… 15 However, the median delay of the health care system was only 7 days in our study, which was much shorter than 12–34 days of health system delay in low- to middle-income countries found in a meta-analysis. 16 A recent study from Ethiopia also reported a 20.5-day delay in health system delay. 22 We supposed that our healthcare system responds quickly when taking care of patients.…”

Section: Discussionmentioning

confidence: 97%

Duration and Determinants of Delayed Diagnosis with Tuberculosis in Shenzhen, China: A Cross-Sectional Study

Jiang¹,

Li²,

Gui³

et al. 2022

RMHP

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Background Early diagnosis and timely treatment of tuberculosis are critical for disease control and management. However, diagnostic delay remains severe around the world. We aim to evaluate the duration and factors associated with diagnostic delay of tuberculosis in Shenzhen, China. Methods We conducted a face-to-face interview to collect the whole care-seeking process of patients diagnosed with active TB in Shenzhen, China, from April 1 to September 30, 2021. The duration from symptom onset to confirmed diagnosis was recorded. The risk factors of diagnostic delay were identified by binary stepwise logistic regression analysis. Results Among 288 confirmed TB cases, 170 (59.0%) were delayed diagnosis. The median diagnostic delay was 39.5 days. Median patient delay was 23 days and health system delay was 7 days. Income ≤315USD/month (OR = 2.97 [95% CI: 1.15–7.69]), cough (OR = 3.00 [95% CI: 1.16–7.76]), weight loss (OR = 15.59 [95% CI: 1.85–131.56]), use of traditional Chinese Medicine (OR = 5.03 [95% CI: 1.04–24.31]) and over-the-counter cough syrup (OR = 2.73 [95% CI: 1.10–6.76]) were significant risk factors for patient delay. Fever (OR = 0.13[95% CI: 0.04–0.48]) and hemoptysis (OR = 0.06 [95% CI0.01–0.30]) were protective factors for patient delay. Cough (OR = 2.85 [95% CI: 1.49–5.49]) and availability of chest X-ray (OR = 0.21[CI: 0.11–0.39]) were factors associated with health system delay. Conclusion Delayed diagnosis of tuberculosis remains an unresolved problem. Patients with low income, self-treatment with over-the-counter medicine and accepting TCM suffered from a higher risk of patient delay. It is important to give more help to the vulnerable people and strengthen tuberculosis knowledge among primary health providers. Keeping all health providers alert to TB symptoms can facilitate earlier TB diagnosis and better disease control.

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“…This review also identified other sociodemographic and economic risk factors for patient delay, such as being older, lower education level, unmarried, being unemployed, absence of health insurance, and high cost of treatment and transportation to health facilities (Table 2). Urban residence [24,56,58] Widowed/di vorced/ separated/n ot married [67,75] Cost of health care incurred before diagnosis [46 ] Sub-urban residence [104 ] Widowed Unemployed [35,36,39] Cost of treatment/ transport to health facilities [86] Unemployed [101] Cost of treatment/ transport to health facilities [47] No health insurance [68,72,73,81] Cost of health care incurred before diagnosis [101 , 104] Behavioral Smoking [37] Recreational drug use [61] Smoking [77] Poor TB knowledge [98] Poor TB knowledge [46,104] Nonsmoking [99] Stigma[25, 40,57] Stigma [72,83] Stigma [ TB-HIV coinfection/HIV positive [30,88] No cough [66] No history of TB [97] Smear positive [78,99] No history of TB in the family [101] Chest pain [107] No history of TB [32,…”

Section: Patient Delaymentioning

confidence: 99%

“…Qualitative data also suggested that the lack of trust in the public health care system perpetuated delays in careseeking [120, 129, 134-137, 141, 142]. Unlike hemoptysis and weight loss, the presence of cough [65,66,70,76,84,86] was associated with patient delay (Fig. 7).…”

Section: Patient Delaymentioning

confidence: 99%

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

Teo¹,

Singh

Prem

et al. 2020

Preprint

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Background: Globally, 30 countries with the highest tuberculosis (TB) burden bears 87% of the world’s TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the determinants and duration of delayed diagnosis and treatment of pulmonary TB in high TB burden countries. Methods: We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. For quantitative studies, we performed narrative synthesis of the covariates that were significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. Results: We included 124 articles from 14 low-and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC) in this review. The pooled median duration of patient, health system, and treatment delay were 28 days (95%CI 20–30), 11.5 days (95%CI 3.9–24.7), and six days (95%CI 1–28.4), respectively. We found that the duration of delays was consistently shorter among UMIC compared to LIC and LMIC. There was consistent evidence that being female and rural residence was associated with longer patient delay. Furthermore, patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Health system and treatment delay were mediated by organizational and policy factors. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high burden countries. Conclusions: This review detailed the determinants of delayed TB diagnosis and treatment in high burden countries. The gaps identified at different socio-ecological levels could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care.

show abstract

Delay of Treatment among New Smear-Positive Pulmonary Tuberculosis Patients in Thai-Cambodia Border: Cases Study in Surin and Sisaket Province, Thailand

Cited by 6 publications

References 3 publications

Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis

Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis

Duration and Determinants of Delayed Diagnosis with Tuberculosis in Shenzhen, China: A Cross-Sectional Study

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

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