Determinants of delayed care seeking for TB suggestive symptoms in Seru district, Oromiya region, Ethiopia: a community based unmatched case-control study

Abstract

BackgroundEarly tuberculosis (TB) case finding and adequate chemotherapy are essential for interrupting disease transmission and preventing complications due to delayed care seeking. This study was undertaken in order to provide insights into the magnitude and determinants of patient delay.MethodsThe study was conducted in rural Seru district, employing a population based unmatched case-control study design. The WHO standardized TB screening tool was used to identify presumptive TB cases among the district population ages > 15 years. Presumptive TB cases who sought care in a health facility more than 14 days after the onset of symptoms were considered cases while those who sought care within the first 14 days were classified as controls. A structured interview questionnaire was used to capture socio demographic characteristics and health care service utilization related data from the study participants. A multiple binary logistic regression model was used to identify any factor associated with patient care seeking delay.ResultA total of 9,782 individuals were screened, of which 980 (10%, 95% CI; 9.4-10.5%) presumptive TB cases were identified. From these cases 358 (76%, 95% CI; 75.6%-76.4%) sought care within the first 14 days of the onset of symptoms with a median patient delay of 15 days, IQR (5-30 days). The most common TB suggestive symptom mentioned by the participants was night sweat 754 (76.4%) while the least common was a history of contact with a confirmed TB case in the past one year 207 (21.1%). Individuals in the 45-54 age range had lower odds of delay (AOR 0.31, 95%CI 0.15, 0.61) as compared to those 15-24 years old. First TB treatment episode (AOR16.2, 95% CI 9.94, 26.26) and limited access to either traditional or modern modes of transportation (AOR 2.62, 95% CI 1.25, 5.49) were independently associated with patient care delay.ConclusionIncreasing community awareness about the risks of delayed care seeking and the importance of accessing health services close to the community can help decrease patient care delay.

Oferta de serviços pela atenção básica e detecção da incidência de tuberculose no Brasil

“…Among the limitations of this study, we can mention the impossibility of establishing a chronological order in the independent variables and the outcome 8 . The organization of PC services may be a response to a high incidence of the disease.…”

“…The provision of supplies and human resources 6 and the presence of family health strategy (FHS) teams in health units 7 are positively associated with case detection. In Ethiopia, delayed diagnosis was associated with non-knowledge about TB and the distance of the health service from the patient's residence 8 . Similarly, a meta-analysis of studies carried out in China has identified, among other factors, that living away from health services (rural area) was associated with delayed TB detection 9 .…”

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

“…Then, efforts can be targeted to the right people with the right interventions based on what segment is most prevalent, most at risk, most easily accessed and most easily 'converted' to the right behaviour. 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.…”

“… 8 Many studies have been conducted both globally 9–14 and in the Indian context 15–20 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, 10–13 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>Factors Associated with Health-Seeking Preference Among People Who Were Supposed to Cough for More Than 2 Weeks: A Cross-Sectional Study in Southeast China</p>

“…11 , 14 The health-seeking delay was affected by an individual’s awareness of TB knowledge, the national TB control policy, health-seeking factors such as the first health-seeking facilities, and socio-demographic features. 15 , 18 …”