Abstract
BackgroundEarly diagnosis and prompt effective therapy are crucial for the prevention of tuberculosis (TB) transmission, particularly in regions with high levels of multi-drug resistant TB. This study aimed to evaluate the extent of delay in diagnosis and treatment of TB in Uzbekistan and identify associated risk factors.MethodsA cross-sectional study was performed on hospital patients with newly diagnosed TB. The time between the onset of respiratory symptoms and initiation of anti-TB treatment was assessed and delays were divided into patient, health system and total delays. Univariable and multivariable logistic regression analysis was used to evaluate determinants of diagnostic and treatment delay.ResultsAmong 538 patients enrolled, the median delay from onset of symptoms until treatment with anti-TB drugs was 50 days. Analysis of the factors affecting health-seeking behaviour and timely treatment showed the presence of the patient factor. Self-medication was the first health-seeking action for 231 (43%) patients and proved to be a significant predictor of delay (p = 0.005), as well as coughing (p = 0.009), loss of weight (p = 0.001), and visiting private and primary healthcare facilities (p = 0.03 and p = 0.02, respectively).ConclusionTB diagnostic and treatment delay was mainly contributed to by patient delay and should be reduced through increasing public awareness of TB symptoms and improving public health-seeking behaviour for timely initiation of anti-TB treatment. Efforts should be made to minimise irrational use of antibiotics and support interventions to restrict over-the-counter availability of antibiotics.
Highlights
Diagnosis and prompt effective therapy are crucial for the prevention of tuberculosis (TB) transmission, in regions with high levels of multi-drug resistant TB
The highest multi-drug resistant TB (MDR-TB) incidence rate exists in Northwestern Karakalpakstan, where the immunity of the population has been undermined by the Aral Sea ecological catastrophe
Study population We reviewed the TB Electronic Surveillance Case-based Management System (ESCM) database of all cases of culture-confirmed pulmonary TB registered in the selected facilities from August 2013 to January 2014
Summary
Diagnosis and prompt effective therapy are crucial for the prevention of tuberculosis (TB) transmission, in regions with high levels of multi-drug resistant TB. The TB epidemic has been fuelled by a surge in HIV–TB co-infection and compounded by the growing emergence of multi- and extensively drug resistant (M/XDR) TB strains, with a high prevalence in the former Soviet Union countries, especially in Central Asia [2,3]. Uzbekistan is one of the four Central Asian states among the 27 identified by the World Health Organization (WHO) with the highest burden of multi-drug resistant TB (MDR-TB). Cotton growing regions suffer because the immunity of the local people has been adversely affected by unlimited application of pesticides [4]
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