Factors associated with patient delay in accessing pulmonary tuberculosis care, Gezira State, Sudan, 2009

Mohamed, Elsadig Yousif; Abdalla, Sawsan Mustafa; Khamis, Abdalla Ali; Abdelbadea, A.; Abdelgadir, M. A.

doi:10.26719/2013.19.2.114

Cited by 11 publications

(15 citation statements)

References 11 publications

(18 reference statements)

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“…The median patient delay was 25 days, similar to those reported in Sudan (27.2 days) [21] , Norway (28 days) [3] , and Bangladesh (28 days) [22] well below that found in Brazil (76 days) [6] and higher than in Indonesia (7 days). [23] In this study, a shorter patient delay occurred in males, those who completed secondary school and in those who had good knowledge of TB symptoms.…”

Section: Discussionsupporting

confidence: 79%

Determinants of delays in diagnosis and treatment of pulmonary tuberculosis in a new urban township in India: A cross-sectional study

Konda¹,

Melo²,

Giri³

et al. 2014

Int J Med Sci Public Health

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Background: The period of infectiousness of a new sputum smear-positive pulmonary tuberculosis case is important in determining the risk of exposure faced by the community. Early detection and effective treatment of TB case reduces the period of transmission and the risk of exposure of the community. It is for this reason that the delay in TB diagnosis and treatment should be minimal to control disease transmission and patient suffering. Aims & Objective: To measure delays in diagnosis and treatment of pulmonary tuberculosis, and to identify and assess the risk factors associated with these delays. Material and Methods: A cross-sectional study was conducted of all new smear-positive pulmonary TB patients diagnosed between January 2012 and June 2013 at RNTCP clinic. The time from the onset of symptoms to first health care consultation (patient delay) and the time from first health care consultation to the date of TB diagnosis (health system delay) were analysed. Bivariate and logistics regression were applied to analyse the risk factors of delays. Results: A total of 122 patients with a mean age of 29.9 years were included in the study. Mean total delay between the onset of symptoms and treatment initiation was 53.42 days (median 50, range 14-128), with a mean patient delay of 29.24 days (median 25, range 5-94) and mean health system delay of 21.7 days (median 17, range 3-93). The mean treatment delay was 2.48 days (median 2, range 1-6). Factors independently associated with total delay were cough symptom (OR 3.36, P = 0.038), completed secondary school (OR 0.41, P = 0.018), good knowledge of TB symptoms (OR 0.39, P = 0.011), first visit to a public health facility (OR 0.45, P = 0.044), sputum testing at first health care consultation (OR 0.46, P = 0.048) and stigma attached to TB disease (OR 2.89, P = 0.021). Those associated with patient delay were male sex (OR 0.42, P = 0.020), large family size (OR 2.30, P = 0.027), completed secondary school (OR 0.43, P = 0.025) and good knowledge of TB symptoms (OR 0.45, P = 0.029); while those associated with health system delay were first visit to a public health facility (OR 0.31, P = 0.006), sputum testing at first health care consultation (OR 0.22, P = 0.001), number of health care consultations (OR 4.41, P < 0.001) and pre-diagnosis health care cost (OR 3.35, P = 0.001). Conclusion: Health system delay was an important problem in the area studied, with patient delay being of most concern.

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Section: Discussionsupporting

confidence: 79%

Determinants of delays in diagnosis and treatment of pulmonary tuberculosis in a new urban township in India: A cross-sectional study

Konda¹,

Melo²,

Giri³

et al. 2014

Int J Med Sci Public Health

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“…26 No. 4 -2020 suspects (1 study) (16), smear negative and smear positive PTB patients (2 studies) (17,18)) and only new smearpositive patients (17 studies) (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Almost all studies used a consecutive method of sampling and sample sizes ranged from 50 to 5702.…”

Section: Study Flow and Description Of Studiesmentioning

confidence: 99%

“…Sixteen studies assessed both sources of delay; 4 assessed only patient delay while 2 assessed total delay without any demarcation between patient and health system delay. Seventeen studies measured the duration of patient delay, of which only 10 analysed the factors attributed to this period (16,22,27,28,(30)(31)(32)(33)(34)(35). Out of 15 studies that measured the duration of health system delay, 6 analysed at least 1 factor associated with this period (22,23,26,32,34,35).…”

Section: Study Flow and Description Of Studiesmentioning

confidence: 99%

“…At least one factor attributing to patient delay was analysed in 10 studies (16,(18)(19)(20)(21)(22)(23)(24)(25)35). Studies mostly assessed predisposing factors such as patient sociodemographic characteristics, TB knowledge and perception about TB.…”

Section: Factors Associated With Patient Delaymentioning

confidence: 99%

“…Predisposing factors that were significantly associated with patient delay were older age (OR = 1.24; 95% CI: 1.02 to 1.50), female sex (OR = 1.42; 95% CI: 1.19 to 1.69), unemployment (OR = 0.83; 95% CI: 0.72 to 0.95), low patient income (OR = 1.95; 95% CI: 1.07 to 3.55) and low crowding index (OR = 0.75; 95% CI: 0.57 to 0.99) ( Figure 2). Factors found to be significantly associated with patient delay were: inadequate TB knowledge (20,25a), although in 4 studies the summary OR was not significant for literacy (16,20,21,35); residing in rural areas (16); presence of chronic health problem (21,22); contact with a TB case (21) [yet protective against delay in another study (19)]; self-medication (25a) [although not significantly associated in another study (23)]; and high cost of medical services (20).…”

Section: Factors Associated With Patient Delaymentioning

confidence: 99%

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Factors associated with tuberculosis diagnosis and treatment delays in Middle East and North Africa: a systematic review

Eltayeb

Pietersen

Engel

et al. 2020

East Mediterr Health J

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Background: Political instability, economic sanctions and substandard quality of health care negatively affect tuberculosis (TB) control in the Middle East and North Africa (MENA) region. Aims: We aimed to elucidate factors contributing to delays in TB diagnosis and treatment in MENA countries. Methods: Two reviewers independently appraised eligible articles identified through comprehensive searching and extracted data which were subjected to meta-analysis. Results: Delays in TB diagnosis were associated with older age and low income [(OR = 1.49; 95% CI: 1.31-1.70) and (OR = 1.26; 95% CI: 1.09-1.45)] respectively (n = 17 studies). Being female was associated with patient delay and health system delay [(OR = 1.24; 95% CI: 1.02-1.50) and (OR = 1.68; 95% CI: 1.18-2.38)] respectively. Knowledge and perception of TB, having employment and low levels of crowding were each protective against patient delay. The GRADE system rated the evidence as of low quality. Conclusion: This review provides evidence for facilitators and barriers to TB diagnosis and health system delays. For successful TB control in the MENA region, TB awareness and interventions targeting the elderly and those from lower-income settings, particularly directed at gender differences, are essential.

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Rural–Urban Inequities in Tuberculosis-Related Practices in Equatorial Guinea

Ayala,

Ncogo,

Eyene

et al. 2023

J Epidemiol Glob Health

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Background Tuberculosis (TB) is one of the leading causes of mortality from a single infectious disease agent. Equatorial Guinea is a country with high estimated TB incidence in 2021 (275 cases per 100,000 population) and low TB case detection (42%). Early diagnosis and prompt treatment are crucial for TB control. Failure to seek adequate health care increases the disease’s transmission and leads to poor treatment outcome, the mortality, even for easily manageable conditions. Information regarding community management of TB and treatment-seeking patterns in Equatorial Guinea is rare. The aim of this study was to explore differences in TB health-seeking behaviour among urban and rural population TB cases in Equatorial Guinea and the factors associated with this behaviour. Methods A national cross-sectional study of 770 household caregivers was conducted in 2020 in Equatorial Guinea using multistage stratified sampling. The 284 caregivers that reported having had a TB case in their family were included in this study. A practice index was created. Poisson regression with robust variance was performed with the practices index as dependent variable to assess the factors associated with the health-seeking behaviour. Results Most of the cases (65%) have had good TB health-seeking practices. However, 23.2% of TB cases reported having abandoned treatment before 6 months. A higher probability of having good TB practices was observed with being women, aged and living in rural area. Those who were TB cases themselves have heard about TB on the radio, and had high knowledge about TB, hand also good practices. Conclusions Disparities in tuberculosis health-seeking behaviour between rural and urban populations highlight the challenges existing in the fight against this infectious disease. The National Tuberculosis Control Program has to reinforce the health system needs to strengthen the follow-up of TB patients taking into account the population at risk of inappropriate TB behaviour. Trial Registration Not applicable.

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Factors associated with patient delay in accessing pulmonary tuberculosis care, Gezira State, Sudan, 2009

Cited by 11 publications

References 11 publications

Determinants of delays in diagnosis and treatment of pulmonary tuberculosis in a new urban township in India: A cross-sectional study

Determinants of delays in diagnosis and treatment of pulmonary tuberculosis in a new urban township in India: A cross-sectional study

Factors associated with tuberculosis diagnosis and treatment delays in Middle East and North Africa: a systematic review

Rural–Urban Inequities in Tuberculosis-Related Practices in Equatorial Guinea

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