Determinants of health system delay at public and private directly observed treatment, short course facilities in Lagos State, Nigeria: A cross-sectional study

Adejumo, Olusola Adedeji; Daniel, Olusoji; Otesanya, Andrew Folarin; Adejumo, Esther Ngozi

doi:10.1016/j.ijmyco.2016.04.004

Cited by 11 publications

(7 citation statements)

References 24 publications

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“…Seven qualitative studies explained that complicated administrative procedures at the health facilities [ 96 , 119 , 126 , 130 , 132 , 133 , 144 ], which could have resulted in longer waiting time [ 46 ], and complex referral system[ 144 ] that eventually prolonged health system delay. This review identified studies reporting that health system delays were associated with visiting lower-level facilities that did not provide TB services [ 34 , 46 , 72 , 75 , 90 ]. Six qualitative studies mentioned that inadequate resources and supplies in health facilities could have delayed TB diagnosis [ 96 , 129 , 130 , 132 , 138 , 144 ].…”

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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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%

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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“…The socioeconomic differences in both genders also result in differential exposure to TB risk factors and TB disease progression. In low- and middle-income countries (LMICs) like Nigeria, women also have less access to health services and TB-specific services, suffer greater delays in TB detection and treatment, and suffer from atypical TB symptoms that are often overlooked by the health systems [ 3 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Gender and Drug-Resistant Tuberculosis in Nigeria

et al. 2023

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We conducted a retrospective study of 2555 DR-TB patients admitted to treatment between 2010 and 2016 in six geopolitical zones in Nigeria. We characterized the gender distribution of DR-TB cases and the association between demographics and clinical data, such as age, treatment category, number of previous TB treatment cycles, and geopolitical zone, with gender. The independent effects of being a male or female DR-TB patient were determined using bivariate and multivariate analyzes with statistical significance of p < 0.05 and a 95% confidence interval. Records from a total of 2555 DR-TB patients were examined for the study. A majority were male (66.9%), largest age-group was 30–39 years old (35.8%), most had MDR-TB (61.4%), were HIV-negative (76.6%), and previously treated for TB (77.1%). The southwest treatment zone had the highest proportion of DR-TB patients (36.9%), and most DR-TB diagnoses occurred in 2016 (36.9%). On bivariate analysis, age, HIV status, treatment zone, and clinical patient group in DR-TB were significantly associated with male gender. On multivariate analysis, males aged 20–29 years (AOR: 0.19, 95% CI: 0.33–0.59, p = 0.001) and HIV-positive males (AOR: 0.44, 95% CI: 0.33–0.59, p = 0.001) had lower likelihood of MDR-TB as males in the south–south treatment zone (AOR: 1.88, 95% CI: 1.23–2.85, p = 0.03), and being male and aged ≥60 years (AOR: 2.19, 95% CI: 1.05–4.54, p = 0.036) increased the probability of DR-TB. The older male population from south–southern Nigeria and women of childbearing age had lower incidence of DR-TB than men of the same age. Tailored interventions to reduce HIV and DR-TB prevalence in the general population, particularly among women of childbearing potential, and treatment support for young and older men are relevant strategies to reduce DR-TB in Nigeria.

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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%

“…Seven qualitative studies identified that complicated administrative procedures at the health facilities [94,117,124,128,130,131,142], which could have resulted in longer waiting time [42], and complex referral system [142] that eventually prolonged health system delay. This review identified that visiting lower-level facilities and those that did not provide TB services [30,42,68,71,88] was associated with health system delay. Six qualitative studies mentioned inadequate resources and supplies in health facilities as such could have delayed TB diagnosis [94,127,128,130,136,142].…”

Section: Health System 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.

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Determinants of health system delay at public and private directly observed treatment, short course facilities in Lagos State, Nigeria: A cross-sectional study

Abstract: Determinants of HSD at the public and private DOTS facilities vary. Strategies to reduce HSD at both public and private DOTS facilities in Lagos State, Nigeria, are urgently needed.

Cited by 11 publications

References 24 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

Gender and Drug-Resistant Tuberculosis in Nigeria

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

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