Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia

Abstract

Background: Delay in the diagnosis of tuberculosis may worsen the disease, increase the risk of death and enhance tuberculosis transmission in the community. This study aims to determine the length of delay between the onset of symptoms and patients first visit to health care (patient delay), and the length of delay between health care visit and the diagnosis of tuberculosis (health service delay).

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

“…Delay was defined as any time period from the onset of symptoms to presentation, to diagnosis, to treatment initiation; or from presentation to diagnosis or treatment initiation; or else from diagnosis to treatment initiation based on their objective of study [14]. Almost all studies reviewed used "patient delay" contextually as the time interval between the onset of major symptoms of TB to the first presentation to formal health care facility [2] [5] [7] [8] [15]- [18]. One study defined "patient delay" as the time interval between the onsets of TB symptoms-and the first formal or informal health care received [19].…”

Delays in the Diagnosis and Treatment of Pulmonary Tuberculosis

“…Although the authors have described different duration intervals for the criteria of delays, the following operational criteria for delays have been usually used in most studies. Patient delay: The patient's application intervals that exceeded 30 days were considered indicative of a patient delay in smear-negative and smear-positive patients (10,12,(20)(21)(22). Health care system delay or doctor delay: While health care system intervals that exceeded four days were considered indicative of a doctor delay in smear-positive patients (10,20,22), a period of more than 15 days was indicative of a doctor delay in smear-negative patients (12,22).…”

“…Treatment delay: The treatment interval that exceed one day was defined as a delayed treatment (10,20,21). Clinical delay: While clinical intervals that exceeded two days were considered indicative of a clinic delay in smear-positive patients, a period of more than 13 days was indicative of a clinical delay in smear-negative patients (10,12,20,22). Total delay: While total intervals that exceeded 34 days were considered indicative of a total delay in smearpositive patients, a period of more than 45 days was indicative of a total delay in smear-negative patients (10,12,20,22).…”

“…Patient delay: The patient's application intervals that exceeded 30 days were considered indicative of a patient delay in smear-negative and smear-positive patients (10,12,(20)(21)(22). Health care system delay or doctor delay: While health care system intervals that exceeded four days were considered indicative of a doctor delay in smear-positive patients (10,20,22), a period of more than 15 days was indicative of a doctor delay in smear-negative patients (12,22). Referral delay: The referral intervals that exceeded two days were considered indicative of a referral delay in smear-negative and smear-positive patients (10,(20)(21)(22).…”

“…It was reported that delays in tuberculosis diagnosis were associated with greater transmission of infection to contacts (9). Delays in the diagnosis and treatment of tuberculosis patients have been commonly reported in both developing and developed countries (10)(11)(12)(13)(14)(15)(16)(17)(18). The current study aimed to discuss the length of delays and possible reasons for delays in pulmonary tuberculosis patients.…”