Reasons for Delay in Seeking Care for Tuberculosis, Republic of Armenia, 2006–2007

Abstract

Background. Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. In Armenia, case reports of active TB increased from 590 to 1538 between 1990 and 2003. However, the TB case detection rate in Armenia in 2007 was only 51%, indicating that many cases go undetected or that suspected cases are not referred for confirmatory diagnosis. Understanding why Armenians do not seek or delay TB medical care is important to increase detection rates, improve treatment outcomes, and reduce ongoing transmission. Methods. Two hundred-forty patients hospitalized between August 2006 and September 2007 at two Armenian TB reference hospitals were interviewed about symptoms, when they sought medical attention after symptom onset, outcomes of their first medical visit, and when they began treatment after diagnosis. We used logistic regression modeling to identify reasons for delay in diagnosis. Results. Fatigue and weight loss were significantly associated with delay in seeking medical attention [aOR = 2.47 (95%CI = 1.15, 5.29); aOR = 2.99 (95%CI = 1.46, 6.14), resp.], while having night sweats protected against delay [aOR = 0.48 (95%CI = 0.24, 0.96)]. Believing the illness to be something other than TB was also significantly associated with delay [aOR = 2.63 (95%CI = 1.13, 6.12)]. Almost 20% of the 240 TB patients were neither diagnosed at their first medical visit nor referred for further evaluation. Conclusions. This study showed that raising awareness of the signs and symptoms of TB among both the public and clinical communities is urgently needed.

Factors associated with patient delay in accessing pulmonary tuberculosis care, Gezira State, Sudan, 2009

“…Economic status seems to play an important role in patient delay to seek TB care, as those with no debts were less likely to delay than people with debts. These findings are in line with reports from the Philippines and Armenia [19,24].…”

“…Those who were housewives Philippines and Ethiopia (30 and 30 days respectively) [19,20], but higher than in Egypt, Pakistan and Botswana (24.3, 9.9 and 21 days respectively) [21,22]. As regards the relation between patient delay and social factors [23], the study revealed similar proportions of younger and older age groups delaying seeking care. This finding was not in agreement with a study conducted in Khartoum state where older age groups delayed longer on average (50.2 versus 64.1 days) [Mustafa MH.…”

“…Slightly more women in our study delayed seeking TB care than did men but the difference was not significant. More women than men delayed in a study in Yemen [21]; but not in reports from Armenia and Brazil [24,25]. Patients living in rural areas were significantly more likely to delay than those living in urban areas [26].…”

Knowledge and health seeking behaviour of tuberculosis patients in Kerala, India

“…2 In other studies a cough as a symptom, extended from 61% -99.1%. [3][4][5][6][7][8] In present study, (45.7%) of patients approached the health facility within two weeks of symptoms. Under the RNTCP, as TB is suspected among those having the cough for ≥2 weeks, the results suggest low level of prompt treatment seeking behaviour.…”

“…It is imperative to explore the factors affecting failure to diagnose at the first visit. 3,6 Identification of these factors would be important from the programme perspective. However, a good proportion of patients who approached a government health facility The amount spent by patients in our study is higher than other studies were done in India by Rajeswari R et al [Rs. 359 (range 0-5000)] and Tobgay KJ et al, Rs 220 (range Rs 0-5120) at Sikkim.…”