Identifying Risk Factors for Pulmonary Tuberculosis Diagnosis Delays in Mali a West-African Endemic Country

Abstract

Background: Tuberculosis was the deadliest infectious agent before covid-19; 1.5 million deaths in 2020. Despite, a variety, of easy and cheap diagnostic tools, detection rates still fall below 90%; diagnosis delays are long exceeding 30 days in many continents. This study aimed to determine risk factors for pulmonary TB diagnosis delays in Mali. Methods: A cross-sectional study was conducted in Bamako to include pulmonary TB patients at treatment initiation centers. Verbal consent was obtained before the interview. Demographics, clinical, treatment cost, and patient, medical, and diagnostic delays were computed using SPSS 25.0 considering a significance level p < 0.05. Results: In total 266 patients were included, 80.8% were male, mean age was ± 12 years, primary education level was 50.4%, treatment cost before diagnosis was 100 - 200 thousand CFA in 65.4%, smokers were 42.1%, median patient, medical and total diagnostic delays were 58, 57 and 114 days respectively. Education level below university, social reasons, and non-request of health workers were identified as independent risk factors for diagnostic delay > 100 days in Mali Conclusion: Diagnostic delay is relatively very long in Mali, there is an urgent need for identification and action to shorten the delays to limit the transmission chain and avoid disabling pulmonary sequels.

Tuberculosis treatment delay and associated factors among pulmonary tuberculosis patients at public health facilities in Dale District and Yirgalem Town administration, Sidama Region, South Ethiopia

“…African studies reported prevalence of 61% in Nigeria in 2012 [ 11 ] and 48% in Zimbabwe in 2014 [ 12 ]. A cross-sectional study in Bamako, Mali reported the median patient delay of TB treatment was 58 days [ 13 ]. Over half (56.3%) of all involved patients delay in seeking health care for more than 30 days after the onset of their TB symptoms [ 14 ].…”

“…Concerning factors associated with patient delay in TB treatment, low income, rural residency, unemployment, old age, and female sex, distance to the DOTs centers, low education level, social reasons and non-request of health workers were the associated factors of patient delay in TB treatment [ 13 , 24 , 25 ]. Factors like lack of knowledge, fear and embarrassment of receiving TB diagnosis, patient tendency to get self-treatment before seeking formal medical care, use of dispensary and private health facilities, employed individuals, secondary-level education and tertiary education, body mass index (BMI) status were also reported as risk factors of patient related TB treatment delay in other settings [ 15 , 18 , 26 ].…”