The identification of risk factors associated with patient and healthcare system delays in the treatment of tuberculosis in Tabriz, Iran

Abstract

BackgroundTuberculosis (TB) is a serious health concern, particularly in developing countries. Various delays, such as patient delay (PD) and healthcare system delay (HSD) in the TB process, are exacerbating the disease burden and increasing the rates of transmission and mortality in various global communities. Therefore, the aim of this study is to identify risk factors associated with PD and HSD in TB patients in Tabriz, Iran.MethodsA cross-sectional study was conducted on 173 TB patients in Tabriz, Iran from 2012 to 2014. Patients were interviewed with a semi-structured questionnaire. Frequencies and percentages were reported for patient categories of sex, age, and education. The median and interquartile range (IQR) were reported for the time intervals of delays. Univariate and multivariate logistic regressions of delay in respect to socio-demographic and clinical variables were performed. Statistical significance was set at p < 0.05.ResultsThe median values for delays were 53 days for HSD (IQR = 73) and 13 days for PD (IQR = 57). Odds ratios (OR) associated with PD were: employed vs. unemployed (OR = 5.86, 95% CI: 1.59 to 21.64); public hospitals vs. private hospitals (OR = 2.64, 95% CI: 1.01 to 6.85); ≥ 3 vs. < 3 visits to health facilities before correct diagnosis (OR = 2.35, 95% CI: 1.08 to 5.11); and male vs. female (OR = 2.28, 95% CI: 1.29 to 4.39). The OR associated with HSD were: ≥ 3 vs. < 3 visits to health facilities before correct diagnosis (OR = 9.44, 95% CI: 4.50 to 19.82), without vs. with access to TB diagnostic services (OR = 3.56, 95% CI: 1.85 to 6.83), and misdiagnosis as cold or viral infection vs. not (OR = 2.62, 95% CI: 1.40 to 4.91).ConclusionsThe results provide for an important understanding of the risk factors associated with PD and HSD. One of the major recommendations is to provide more TB diagnostic knowledge and tools to primary health providers and correct diagnoses for patients during their initial visit to the health care facilities. The knowledge generated from this study will be helpful for prioritizing and developing strategies for minimizing delays, initiating early treatment to TB patients, and improving TB-related training programs and healthcare systems in Tabriz, Iran.

Patient pathways and delays to diagnosis and treatment of tuberculosis in an urban setting in Indonesia

“…Consistent with other studies we also found an association of lower education level with longer delay [10] , indicating a need for interventions to increase awareness and knowledge about TB in the general population. Our findings of longer delay among men is supported by some [ 31 , 32 ], but not all studies [ 11 , 12 ]. The association between health insurance ownership and earlier presentation and treatment is consistent with the findings of a recent study in Vietnam; having health insurance influences patients’ behavior towards seeking care from a formal HCP [33] .…”

Gridlock from diagnosis to treatment of multidrug-resistant tuberculosis in Tanzania: low accessibility of molecular diagnostic services and lack of healthcare worker empowerment in 28 districts of 5 high burden TB regions with mixed methods evaluation

“…The majority of front-line healthcare workers, as represented by DACs and DTLCs surveyed, demonstrated opportunity for knowledge improvement on the use of molecular diagnostics, and knowledge was more deficient for GenotypeMTBDR plus compared to XpertMTB/RIF, and for both technologies in DACs compared to DTLCs. While these knowledge gaps are not dissimilar from recent studies of front-line healthcare workers in other sub-Saharan African countries and elsewhere regarding molecular diagnostics for TB [17], the scale of effect was profound. Only 40% of previously treated TB cases were tested for MDR-TB, lower than the global estimate of 60% [1], and when accounting for the those tested but for whom results were not communicated to the clinic, only 30% of all cases of presumed MDR-TB received the opportunity for the most accurate and effective treatment, which is exceptionally low compared to other settings [18].…”

Patient delay and associated factors among tuberculosis patients in Gamo zone public health facilities, Southern Ethiopia: An institution-based cross-sectional study

“…Factors contributing to patient delay (PD) include family size, occupation, the income of the family, stigma, knowledge about TB, first visit informal provider, distance to the health facility, and self-medication [11][12][13][14]. There are growing numbers of studies on diagnostic and treatment delays.…”