Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study

Abstract

BackgroundTuberculosis (TB) is a major public health concern in the developing world. Early diagnosis and prompt initiation of treatment is essential for effective TB control. The aim of this study was to determine the length and analyze associated factors of patients’ and health system’s delays in the diagnosis and treatment of new pulmonary TB (PTB) patients.MethodsA cross-sectional study was conducted in 30 randomly selected public health facilities in West Gojjam Zone, Amhara Region, Ethiopia. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study. Patients’ delay (the time period from onset of TB symptoms to first presentation to a formal health provider) and health system’s delay (the time period from first presentation to a formal health provider to first start of TB treatment) were measured. Median patients’ and health system’s delays were calculated. Mixed effect logistic regression was used to analyze predictors of patients’ and health system’s delays.ResultsSeven hundred six patients were enrolled in the study. The median patients’ delay was 18 days (interquartile range [IQR]: 8–34 days) and the median health system’s delay was 22 days (IQR: 4–88 days). Poor knowledge of TB (adjusted odds ratio [AOR], 2.33; 95 % confidence interval [CI], 1.34–4.05), first visit to non-formal health provider (AOR, 47.56; 95 % CI, 26.31–85.99), self-treatment (AOR, 10.11; 95 % CI, 4.53–22.56) and patients’ age (≥45 years) (AOR, 2.99; 95 % CI, 1.14–7.81) were independent predictors of patients’ delay. Smear-negative TB (AOR, 1.88; 95 % CI, 1.32–2.68) and first visit to public health centers (AOR, 2.22; 95 % CI, 1.52–3.25) and health posts (AOR, 5.86; 95 % CI, 1.40–24.39) were found to be independent predictors of health system’s delay.ConclusionsThe health system’s delay in this study was long and contributed more than 50 % of the total delay. Better TB diagnostic tools to complement sputum smear microscopy are needed to early diagnose PTB cases at peripheral health facilities. In addition, due emphasis should be given to increase public awareness about symptoms and consequences of TB disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1995-z) contains supplementary material, which is available to authorized users.

Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria

“…Weak TB service delivery system was found as a key constraint to TB control. Consistent with findings of previous studies [5,29,30], integration of TB into general health services was weak. Social stigma and concern for contracting TB meant that health workers refuse deployment to and participation in TB control programmes.…”

“…Poor adherence to GeneXpert algorithm, interrupted supply of cartridges, lack of replacement of damaged modules, poor maintenance, and poor recording and reporting limit usefulness of GeneXpert in TB diagnosis [14,26,27]. Poor adherence to national guidelines [11,22,23]; dilapidated infrastructure [5,12,23] weak TB/HIV integration [10,12,14,24,28]; lack of public-private mix [10,12,23] and poor integration into general health services hinder effective TB service delivery [5,29,30].…”

Diagnostic pathways and direct medical costs incurred by new adult pulmonary tuberculosis patients prior to anti-tuberculosis treatment – Tamil Nadu, India

“…We observed a median health system delay of 21 days (10–30 IQR) and the maximum was 365 days. The magnitude of health systems delay observed in other studies in different settings in India ranged from a median of 13 to 54 days [ 18 , 19 , 27 , 28 ] and a median of 5 to 22 days in other countries [ 29 – 31 ]. Delays in treatment initiation further increase the probability of TB transmission in the community and amongst health professionals.…”

Delay from symptom onset to treatment start among tuberculosis patients in England, 2012–2015

“…Our study showed that TB cases who were female, aged 45 years and older, UK-born, resided outside London or had extrapulmonary TB were significantly more likely to have a delay in diagnosis of more than 4 months between onset of symptoms and starting treatment. Studies in similar countries with low TB incidence have described similar factors associated with diagnostic delay; however, none have used national-level data [4][5][6][7][8][9][10][11][12][13][14][15]. There has been one previous study in the UK using national leveldata to assess diagnostic delay among index cases and their contacts within households, which found that there was a median delay of 65 days for index cases and 61 days for subsequent symptomatic cases [16].…”