Explaining patient delay in healthcare seeking and loss to diagnostic follow-up among patients with presumptive tuberculosis in Tanzania: a mixed-methods study

Abstract

Background Delay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality. We examined factors, including perceived causes and prior help seeking, contributing to delay and LDFU during referral to a TB clinic among patients with presumptive TB initially seeking help at the pharmacies in Dar es Salaam Tanzania. Methods In a TB clinic, a semi-structured interview based on the explanatory model interview catalogue (EMIC) framework for cultural epidemiology was administered to presumptive TB patients enrolled at pharmacies during an intervention study. We assessed delay in seeking care at any medical care provider for a period of ≥3 weeks after the onset of symptoms, LDFU during referral (not reaching the TB clinic), and LDFU for three required TB clinic visits among the presumptive and confirmed TB patients. Logistic regression models were used to assess factors associated with delay and LDFU. Results Among 136 interviewed patients, 86 (63.2%) were LDFU from pharmacies and TB clinic while 50 (36.8%) were non-LDFU. Out of 136 patients 88 (64.7%) delayed seeking care, of whom 59 (67%) were females. Among the 86 (63.2%) patients in LDFU group, 62 (72.1%) delayed seeking care, while among the 50 (36.8%) non-LDFU, 26 (52.0%) had also delayed seeking care. Prior consultation with a traditional healer (aOR 2.84, 95% CI 1.08–7.40), perceived causes as ingestion (water and food) (aOR 0.38 CI 0.16–0.89), and substance use (smoking and alcohol) (aOR 1.45 CI 0.98–2.14) were all associated with patient delay. Female gender was associated with LDFU (aOR 3.80, 95% CI 1.62–8.87) but not with delay. Other conditions as prior illness and heredity were also associated with LDFU but not delay (aOR 1.48 CI 1.01–2.17). Conclusion Delay and LDFU after referral from the pharmacies were substantial. Notable effects of diagnosis and female gender indicate a need for more attention to women’s health to promote timely and sustained TB treatment. Public awareness to counter misconceptions about the causes of TB is needed.

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

“…In south-east Ghana, more than a quarter of presumptive TB patients never submitted a sputum, and non-submission of sputum was most strongly associated with longer distance to the laboratory. Studies from Zimbabwe, India and Tanzania have also reported high pre-diagnosis loss-to-follow, 25%, 30.4% and 44% respectively [16][17][18], and some studies, including one from Ghana, showed that attending rural health clinics and long travel distance were risk factors for delay or pre-diagnosis loss to follow-up [7,10,17,19]. In contrast, pre-diagnosis attrition was lower in South Africa and China (5% and 11% respectively) [20,21], perhaps because in South Africa, sputum specimens are transported free to a central laboratory for diagnosis.…”

“…The main reasons given by participants for not submitting sputum were being too busy to go to the laboratory (58/116, 50.0%), feeling well so not seeing the need to do the test (19,16.4%), having no money to travel to do the test (17, 14.7%) and being unable to produce sputum (15, 12.9%).…”

Predictors of three-month mortality among hospitalized older adults in Togo

“…In general, in Africa, the population does not consult a health professional when rst symptoms appear. In most cases, people use traditional medicine or self-medicate and only consult when the condition becomes life-threatening [32,33]. Also, most older adults in Africa do not have health insurance and they have to make out-of-pocket payments for healthcare services.…”

Predictors of three-month mortality among hospitalized older adults in Lomé, Togo

“…In general, in Africa, the population does not consult a health professional when rst symptoms appear. In most cases, people use traditional medicine or self-medicate and only consult when the condition becomes life-threatening [32,33]. Also, most older adults in Africa do not have health insurance and they have to make out-of-pocket payments for healthcare services.…”