Explaining patient delay in healthcare seeking and loss to diagnostic follow-up among patients with presumptive tuberculosis in Tanzania: a mixed-methods study

Grace Mhalu,Elisabeth Zemp,Mitchell G Weiss,Klaus Reither,Francis Mhimbira,Sonja Merten,Lukas Fenner,Enos Mahongo,Christian Schindler,Jerry Hella

doi:10.1186/s12913-019-4030-4

Abstract

BackgroundDelay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality. We examined factors, including perceived causes and prior help seeking, contributing to delay and LDFU during referral to a TB clinic among patients with presumptive TB initially seeking help at the pharmacies in Dar es Salaam Tanzania.MethodsIn a TB clinic, a semi-structured interview based on the explanatory model interview catalogue (EMIC) framework for cultural epidemiology was administered to presumptive TB patients enrolled at pharmacies during an intervention study. We assessed delay in seeking care at any medical care provider for a period of ≥3 weeks after the onset of symptoms, LDFU during referral (not reaching the TB clinic), and LDFU for three required TB clinic visits among the presumptive and confirmed TB patients. Logistic regression models were used to assess factors associated with delay and LDFU.ResultsAmong 136 interviewed patients, 86 (63.2%) were LDFU from pharmacies and TB clinic while 50 (36.8%) were non-LDFU. Out of 136 patients 88 (64.7%) delayed seeking care, of whom 59 (67%) were females. Among the 86 (63.2%) patients in LDFU group, 62 (72.1%) delayed seeking care, while among the 50 (36.8%) non-LDFU, 26 (52.0%) had also delayed seeking care. Prior consultation with a traditional healer (aOR 2.84, 95% CI 1.08–7.40), perceived causes as ingestion (water and food) (aOR 0.38 CI 0.16–0.89), and substance use (smoking and alcohol) (aOR 1.45 CI 0.98–2.14) were all associated with patient delay. Female gender was associated with LDFU (aOR 3.80, 95% CI 1.62–8.87) but not with delay. Other conditions as prior illness and heredity were also associated with LDFU but not delay (aOR 1.48 CI 1.01–2.17).ConclusionDelay and LDFU after referral from the pharmacies were substantial. Notable effects of diagnosis and female gender indicate a need for more attention to women’s health to promote timely and sustained TB treatment. Public awareness to counter misconceptions about the causes of TB is needed.

Highlights

Delay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality
Individuals with TB symptoms may present themselves to healthcare facilities for TB diagnosis [2,3,4] the problem of delayed appropriate help seeking for people with TB symptoms is widespread in sub-Saharan African countries [5]
Research suggests that factors contributing to delay in reaching specialized healthcare facilities and loss to diagnostic follow-up (LDFU) include dissatisfaction with health services, use of self-prescribed medication and initial help seeking with traditional healers [12,13,14]

Summary

Introduction

Delay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality. Individuals with TB symptoms may present themselves to healthcare facilities for TB diagnosis [2,3,4] the problem of delayed appropriate help seeking for people with TB symptoms is widespread in sub-Saharan African countries [5]. Research suggests that factors contributing to delay in reaching specialized healthcare facilities and loss to diagnostic follow-up (LDFU) include dissatisfaction with health services, use of self-prescribed medication and initial help seeking with traditional healers [12,13,14]. LDFU leads to poor health outcomes for the individuals such as increased morbidity, decreasing the quality of life and increasing mortality [15].

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Discussion

Conclusion