Factors associated with treatment delay among tuberculosis patients referred from a tertiary hospital in Dhaka City: a cross-sectional study

Htike, Win; Islam, Md. Akramul; Hasan, Tanvir; Ferdous, S; Rifat, Mahfuza

doi:10.5588/pha.13.0067

Cited by 9 publications

(5 citation statements)

References 14 publications

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“…The findings of the study are in agreement with Mesfin et al 42 and Lin et al, 36 studies from Northern Ethiopia and China, respectively, who reported higher delays in old age patients than young patients. However, our findings are dissimilar to those of Htike et al, 33 who conducted a study in Dhaka city of Bangladesh, and Saqib et al 35 from Punjab, Pakistan. They reported that patients of younger age experienced more treatment delay than older patients.…”

Section: Discussioncontrasting

confidence: 99%

“…Patients' socioeconomic characteristics play an important role in their treatment delay. For instance, age, 13,31,33,36 sex, 2,31,33,34,36 marital status, 33,34 residence, 31,36 educational status, 31,34 monthly income, 13 occupational status, family size, stigma, 34 distance to health facility, 31,34 and knowledge about TB 34 were significant factors associated with treatment delay.…”

Section: Discussionmentioning

confidence: 98%

“…In multivariate logistic regression, we included variables with a significance level P £ 0.25. 33,34…”

Section: Methodsmentioning

confidence: 99%

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Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program

Saqib

Ahmad

Amezcua‐Prieto

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Delay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances transmission of tuberculosis (TB) in the community. Therefore, this study aims to assess treatment delay and its associated factors among pulmonary TB patients in Pakistan. A cross-sectional study was conducted among 269 pulmonary TB patients in the district. Binary and multivariate logistic regressions were used to explore the factors associated with delay in TB treatment. Results reveal that most patients were from low socioeconomic backgrounds. For example, 74.7% were living in houses, 54.7% were from lowest the income group (< 250 US$/month), 60.2% married, 54.3% illiterate, 62.5% rural, 56.1% had no house ownership, and 56.5% had insufficient income for daily family expenditures. Significant delays were revealed by this study: 160 patients had experienced a delay of more than 4 weeks, whereas the median delay was 5 weeks. Results show that the most important reason for patient delay was low income and poverty (42.0%) followed by unaware of TB center (41.6), stigma (felt ashamed = 38.7%), and treatment from local traditional healers. Old age (adjusted odds ratio [AOR] = 6.6; 95% confidence interval [CI] = 1.63-26.95); and rural areas patients (AOR = 2.1; 95% CI = 1.15-3.71) were more likely to have experienced delay. However, the higher income and sufficient income category (AOR = 0.5; 95% CI = 0.31-0.95) were associated factors and less likely to experience delay in patient treatment. Integrative prevention interventions, such as those involving community leaders, health extension workers such as lady health workers, and specialized TB centers, would help to reduce delay and expand access to TB-care facilities.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 98%

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Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program

Saqib

Ahmad

Amezcua‐Prieto

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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“…Four qualitative studies mentioned self-perception of health, unconvinced diagnosis and need for TB treatment, and the perceived low effectiveness of TB treatment led to a delay in TB treatment initiation [ 48 , 96 , 119 , 141 ]. We also found that retreatment cases were more likely to delay TB treatment initiation [ 94 – 98 ].…”

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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“…Four qualitative studies mentioned self-perception of health, and unconvinced of the diagnosis and the need for TB treatment, and the perceived low effectiveness of TB treatment led to a delay in TB treatment initiation [44,94,117,139]. We also found that retreatment cases were more likely to delay TB treatment initiation [92][93][94][95][96].…”

Section: Treatment Delaymentioning

confidence: 64%

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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Factors associated with treatment delay among tuberculosis patients referred from a tertiary hospital in Dhaka City: a cross-sectional study

Cited by 9 publications

References 14 publications

Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program

Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program

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

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

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