Diagnostic and treatment delay among Tuberculosis patients in Afar Region, Ethiopia: A cross-sectional study

Abstract

BackgroundTB is a major public health problem globally and Ethiopia is 8th among the 22 high burden countries. Early detection and effective treatment are pre-requisites for a successful TB control programme. In this regard, early health seeking action from patients’ side and prompt diagnosis as well as initiation of treatment from the health system’s side are essential steps. The aim of this study was to assess delay in the diagnosis and treatment of TB in a predominantly pastoralist area in Ethiopia.MethodsOn a cross-sectional study, two hundred sixteen TB patients who visited DOTS clinics of two health facilities in Afar Region were included consecutively. Time from onset of symptoms till first consultation of formal health providers (patients’ delay) and time from first consultation till initiation of treatment (health system’s delay) were analyzed.ResultsThe median patients’ and health system’s delay were 20 and 33.5 days, respectively. The median total delay was 70.5 days with a median treatment delay of 1 day. On multivariate logistic regression, self-treatment (aOR. 3.99, CI 1.50-10.59) and first visit to non-formal health providers (aOR. 6.18, CI 1.84-20.76) were observed to be independent predictors of patients’ delay. On the other hand, having extra-pulmonary TB (aOR. 2.08, CI 1.08- 4.04), and a first visit to health posts/clinics (aOR. 19.70, CI 6.18-62.79), health centres (aOR. 4.83, CI 2.23-10.43) and private health facilities (aOR. 2.49, CI 1.07-5.84) were found to be independent predictors of health system’s delay.ConclusionsThere is a long delay in the diagnosis and initiation of treatment and this was mainly attributable to the health system. Health system strengthening towards improved diagnosis of TB could reduce the long health system’s delay in the management of TB in the study area.

Delay in Tuberculosis Diagnosis among Tuberculosis Patients at the Three Hospitals: Asella, Robe and Abomsa of Arsi Zone, Oromia Regional State, March, 2015

“…Two studies conducted in two different settings at different time period documented similar findings of patient delay (60 days) [8] [15]. Whereas another two studies conducted in a population of similar setting reported significantly different patient delays (20 versus 60 days) [3] [8]. Other studies from Tigray region and Wollega zone showed 53% and 62% of TB patients delay for diagnosis respectively [4] [5].…”

“…First visit to government clinics/health post, health centers and private health facilities, patient with good functional status, patients in contact with more than two health providers associated with health service's delay [3] [7].…”

“…Health system delay [6] [18], Medical provider delay [8] or Health service delay [15] was used to define the time interval from the first consultation at any formal health facility up to the date of diagnosis. Many other studies used the health system delay [3] [16] [20], health service delay [19] and health provider delay [7] more comprehensively to mean the time interval from first consultation up to treatment initiation.…”

“…Two Studies from Ethiopia used the 2 weeks [7], and 21 days [2] as cut-off points to measure delay based on the World Health Organization's (WHO's) criteria to suspect TB for patients coughing for 2 -3 weeks. The other studies [3] [8] [19] used median delay as cut-off points. As to the health service delay; one study from Chad [19], two studies from Ethiopia [3] [8] used median delay as cut-off point, where us the other three studies from Ethiopia used 7 days [7], 15 days [15] and 2 weeks [6] as cut-off point.…”

“…The other studies [3] [8] [19] used median delay as cut-off points. As to the health service delay; one study from Chad [19], two studies from Ethiopia [3] [8] used median delay as cut-off point, where us the other three studies from Ethiopia used 7 days [7], 15 days [15] and 2 weeks [6] as cut-off point. One study used different cut-off points based on types of TB to measure health service delay as 5 days for SM+ TB and 10 days for SM− TB [22].…”