Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis

Abstract

Background Delay in the diagnosis of Tuberculosis (TB) remains a major challenge against achieving effective TB prevention and control. Though a number of studies with inconsistent findings were conducted in Ethiopia; unavailability of a nationwide study determining the median time of patient delays to TB diagnosis is an important research gap. Therefore, this study aimed to determine the pooled median time of the patient delay to TB diagnosis and its determinants in Ethiopia. Methods We followed PRISMA checklist to present this study. We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. The comprehensive search for relevant studies was done by two of the authors (MA and LY) up to the 10th of October 2019. Risk of bias was assessed using the Newcastle-Ottawa scale adapted for observational studies. Data were pooled and a random effect meta-analysis model was fitted to provide the overall median time of patient delay and its determinants in Ethiopia. Furthermore, subgroup analyses were conducted to investigate how the median time of patient delay varies across different groups of studies. Results Twenty-four studies that satisfied the eligibility criteria were included. Our meta-analysis showed that the median time of the patient delay was 24.6 (95%CI: 20.8–28.4) days. Living in rural area (OR: 2.19, 95%CI: 1.51–3.18), and poor knowledge about TB (OR: 2.85, 95%CI: 1.49–5.47) were more likely to lead to prolonged delay. Patients who consult non-formal health providers (OR: 5.08, 95%CI: 1.56–16.59) had a prolonged delay in the diagnosis of TB. Moreover, the narrative review of this study showed that age, educational level, financial burden and distance travel to reach the nearest health facility were significantly associated with a patient delay in the diagnosis of TB. Conclusions In conclusion, patients are delayed more-than three weeks in the diagnosis of TB. Lack of awareness about TB, consulting non-formal health provider, and being in the rural area had increased patient delay to TB diagnosis. Increasing public awareness about TB, particularly in rural and disadvantaged areas could help to early diagnosis of TB.

Tuberculosis Knowledge and Delayed Health Care Seeking Among New Diagnosed Tuberculosis Patients in Primary Health Facilities in an Urban District, South Africa

“…In accordance with prior studies in SSA, seeking treatment from informal providers before visiting the health facilities was associated with delay in seeking healthcare. 5,7,14,39-41 However, in the current study, a significant association was observed at the univariate logistic regression analysis. The results showed that 32% of patients sought care at health facilities after informal treatment failed.…”

“…Systematic reviews on studies conducted in low middle income countries identified a wide range of factors affecting delay in the diagnosis and treatment of TB that were related to individual, socio-demographic, economic, and health system factors, as well as clinical characteristics. 7,8 In addition, the belief that TB is always associated with HIV and stigma contribute to delayed diagnosing and treatment-seeking. 9,10 Evidence indicates that delay in diagnosis and treatment of TB and the spread of TB is high in communities with low levels of knowledge about the mode of transmission, symptoms, cause, and preventive methods of TB.…”

Impact of COVID-19 Pandemic on Pre-Treatment Delays, Detection, and Clinical Characteristics of Tuberculosis Patients in Ningxia Hui Autonomous Region, China

“…If not totally missed, delayed identification and diagnosis of TB cases also plays an important role in the transmission and aggravation of TB (24). The delay may be due to patients' delay if the patients could not visit a health facility timely after the onset of symptoms or health system delay if the patients are not diagnosed timely at the time of the first visit (25). The containment measures implemented in the whole country have induced disruption in TB services, and the restriction of traffic is impairing access to seeking medical care during the lockdown period of 2020 (26).…”

Impact of Protracted Displacement on Delay in the Diagnosis Associated with Treatment Outcomes: A Cross-Sectional Study in Internally Displaced Tuberculosis Patients of Pakistan

“…Furthermore, distance from the TB center of more than 30 km is responsible for an unacceptable delay in patient care. This is supported by a considerable number of studies, systematic reviews and meta-analyses which specified that patients who travel a long distance to reach healthcare services experienced longer delays [51][52][53].…”