Treatment Delay among Smear Positive Pulmonary Tuberculosis Patients in South Ethiopia: A Cross-Sectional Study

Abstract

Abstract:Background: Most tuberculosis (TB) patients were not visiting heath facility but transmit disease to healthy individuals in the community for longer time in Ethiopia. This study was aimed at estimating duration of delay for initiation of anti-TB treatment by smear positive pulmonary TB in south Ethiopia and assesses its determinants of patient related factors associated with unacceptable delay for medication of TB. Methods: a cross-sectional study design was used to recruit 218 consecutive smear positive pulmonary TB patients visiting there hospitals in Gamo Goffa Zone. A structured questionnaire was used to collect information on socio demographic, economic, behavioral factors and co morbidity with HIV from the study units. The median delay was used as cut-off point to dichotomize acceptable delay from unacceptable one. Pearson chi square and logistic regressions were used to assess association between patient factors and longer delay before treatment. Results: The median delay for initiation of anti-TB medication by smear positive pulmonary TB patients was 35 days. Fifteen of the study participants were HIV positive and equal number of TB patients involved had previous history of TB. Socio-demographic factors significantly associated with longer delay for treatment of TB in Univariate analysis were place of residence, level of education and marital status while economic factors associated were monthly income, whether the house is owned or rented and ceiling status of the house. However, after controlling the effect of confounding variables only place of residence and monthly income remained statistically significant. TB patients from rural area were 2.82 times at increased risk to delay for longer days than those living in the town (p-value= 0.021). Similarly, patients having monthly income of 450 or less Ethiopian birr were 4.96 times more likely to delay for longer time than those who had no regular monthly income (p-value=0.003). Conclusion: Smear positive pulmonary TB patients delay for more days before taking anti-TB medications which renders them noninfectious after a few weeks of treatment began. They were transmitting the disease in the community making prevention and control more difficult. Those living in the rural area and earn least amount of money per month transmit the disease for longer time. Civil servants who earn the least salary per month had significant increment in the salary recently that might prevent their delay. However, access to diagnosis and treatment of TB for people living in the rural area should be improved so as to help the walk towards the millennium development goal targets.

Total Delay in Treatment of Tuberculosis and Associated Factors among New Pulmonary TB Patients in Selected Health Facilities of Gedeo Zone, Southern Ethiopia, 2017/18

“…In the present study, it was found that there was an overall 50.9% (95% CI, 45.4-55.7) prevalence of unacceptable total delay in treatment of TB. This observed result is in line with a previous study in Uzbekistan [11]; Arsi Zone, Ethiopia [20]; Southern Ethiopia [25]; Afar region [28]; Arbaminch, Ethiopia [21]; and West Gojjam, Ethiopia [17], with 50%, 48.9%, 49%, 50%, 46%, and 50% of patients with observed unacceptable delay, respectively.…”

“…Having rural residency among the study participants was also reported as associated factor for unacceptable total delay in treatment of TB development in this study. This is similar with study done in Mediterranean region, Pakistan and Somalia [3], Nigeria [13], and three studies from Ethiopia (10 DOTS districts of Ethiopia [33], North Wollo zone [35], and Arbaminch [21]). This may be explained such that rural residency may limit the study participants to have appropriate access to health information and health facilities than the urban residency.…”

“…This finding is higher than that of study done in India [15]; Uganda [12]; Nepal [19]; Arsi Zone, Ethiopia [20]; and Arbaminch, Ethiopia [21], with a median total treatment delay of 36 days, 28 days, 39.5 days, 40 days, and 35 days, respectively. This difference may be due to socioeconomical difference of access to TB care (available diagnostic facilities), inclusion/exclusion criteria, and sample size.…”

Factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia

“…Rural residents had higher odds of patient delay compared to the urban residents in health-seeking which was supported by studies done in Ethiopia [ 27 , 31 , 32 ], and Mediterranean region [ 7 ]. This might be related to the poor access of rural residents to health information and health facilities compared to the urban residents.…”

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

“…The average time of patient delay in the diagnosis of TB and its determinants were reported by a number of studies [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. However, the reported average time and determinant factors in these fragmented studies vary depending on the characteristics of study participants, the type of design employed and the variables analyzed.…”