Abstract
Background: Healthcare-seeking behavior is the basis to ensure early diagnosis and treatment of tuberculosis (TB) in settings where most cases are diagnosed upon self-presentation to health facilities. Yet, many patients seek delayed healthcare. Thus, we aimed to identify the determinants of patient delay in diagnosis of pulmonary TB in Somali pastoralist area, Ethiopia. Methods: A matched case-control study was conducted between December 2017 and October 2018. Cases were self-presented and newly diagnosed pulmonary TB patients aged ≥ 15 years who delayed > 30 days without healthcare provider consultation, and controls were patients with similar inclusion criteria but who consulted a healthcare provider within 30 days of illness; 216 cases sex-matched with 226 controls were interviewed using a pre-tested questionnaire. Hierarchical analysis was done using conditional logistic regression. Results: After multilevel analysis, pastoralism, rural residence, poor knowledge of TB symptoms and expectation of self-healing were individual-related determinants. Mild-disease and manifesting a single symptom were disease-related, and >1 h walking distance to nearest facility and care-seeking from traditional/religious healers were health system-related determinants of patient delay > 30 days [p < 0.05]. Conclusion: Expansion of TB services, mobile screening services, and arming community figures to identify and link presumptive cases can be effective strategies to improve case detection in pastoral settings.
Highlights
Healthcare-seeking behavior is the basis to ensure early diagnosis and treatment of tuberculosis (TB) in settings where most cases are diagnosed upon self-presentation to health facilities
442 pulmonary TB (PTB) patients (216 cases and 226 controls) aged ≥ 15 years were included in the study
Half (50%) of the patients walked over 40 minutes and 25% walked two or more hours to reach any nearest health facility with/without TB diagnostic services
Summary
Healthcare-seeking behavior is the basis to ensure early diagnosis and treatment of tuberculosis (TB) in settings where most cases are diagnosed upon self-presentation to health facilities. We aimed to identify the determinants of patient delay in diagnosis of pulmonary TB in Somali pastoralist area, Ethiopia. Ethiopia reported an estimated 172,000 new TB cases, which made the country 11th among the high burden and 4th in Africa [1]. The disease burden is higher in pastoralist communities of the country including the Somali Region [2]. The global End-TB strategy targets to end the epidemic by the upcoming decade using early detection of TB cases and prompt initiation of treatment as principal tools [3]. To achieve the global targets, the national TB control program (NTP) of Ethiopia implements
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