The magnitude and factors associated with delays in management of smear positive tuberculosis in Dar es Salaam, Tanzania

Abstract

ObjectiveTo assess the magnitude and factors responsible for delay in TB management.DesignA cross sectional hospital based survey in Dar es Salaam region, May 2006.ResultsWe interviewed 639 TB patients. A total of 78.4% of patients had good knowledge on TB transmission. Only 35.9% had good knowledge on the symptoms. Patient delay was observed in 35.1% of the patients, with significantly (X2 = 5.49, d.f. = 1, P = 0.019) high proportion in females (41.0%) than in males (31.5%). Diagnosis delay was observed in 52.9% of the patients, with significantly (X2 = 10.1, d.f. = 1, P = 0.001) high proportion in females (62.1%) than in males (47.0%). Treatment delay was observed in 34.4% of patients with no significant differences among males and females. Several risk factors were significantly associated with patient's delays in females but not in males. The factors included not recognizing the following as TB symptoms: night sweat (OR = 1.92, 95% CI 1.20, 3.05), chest pain (OR = 1.62, 95% CI 1.1, 2.37), weight loss (OR = 1.55, 95% CI 1.03, 2.32), and coughing blood (OR = 1.47, 95% CI 1.01, 2.16). Other factors included: living more than 5 Km from a health facility (OR = 2.24, 95% CI 1.41, 3.55), no primary education (OR = 1.74, 95% CI 1.01, 3.05) and no employment (OR = 1.77, 95% CI 1.20, 2.60). In multiple logistic regression, five factors were more significant in females (OR = 2.22, 95% CI 1.14, 4.31) than in males (OR = 0.70, 95% CI 0.44, 1.11). These factors included not knowing that night sweat and chest pain are TB symptoms, a belief that TB is always associated with HIV infection, no employment and living far from a health facility.ConclusionThere were significant delays in the management of TB patients which were contributed by both patients and health facilities. However, delays in most of patients were due to delay of diagnosis and treatment in health facilities. The delays at all levels were more common in females than males. This indicates the need for education targeting health seeking behaviour and improvement in health system.

Atraso no diagnóstico da tuberculose em sistema prisional: a experiência do doente apenado

“…This last criterion is based on scientific studies that present a definition for the delay in the diagnosis of TB attributed to patient. [9][10] Through access to the hospitalization information system, patients were identified who were in the position of prisoners, and consequently, the study sample was constituted by those who, during the data collection period, were being treated in the sector, met the sampling criteria cited and agreed to participate in the study.…”

“…8 In the present study, a length of time greater than thirty days elapsed between the onset of signs and symptoms and the first medical consultation for the diagnosis is considered a delay in diagnosis of TB, attributed to the patient, based on categories presented in scientific productions. [9][10] Contextualizing the problem of TB control in the prison system, and considering the conditions of production of the experience of becoming sick in prisons, this study aims to analyze the causes of delay in the diagnosis of TB in the prison system, according to the experience of the incarcerated patient.…”

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).…”

“…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). Diagnosis delay: The diagnosis interval that exceed one day was considered indicative of a delayed diagnosis in smear-positive patients (10,20).…”

“…Diagnosis delay: The diagnosis interval that exceed one day was considered indicative of a delayed diagnosis in smear-positive patients (10,20). 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).…”