Abstract
BackgroundDelayed treatment of tuberculosis (TB) cases increases the risk of death and rate of infection in the community. Early diagnosis and initiation of treatment is essential for effective TB control. The aim of this study was to assess length of delays and analyze predictors of treatment delay of newly diagnosed TB patients.MethodsA cross-sectional study was conducted in Dessie city and surroundings from April1, 2016 to January 30, 2017. Fifteen health facilities of study area were selected randomly and 382 adult TB patients were included consecutively. Data were collected using a questionnaire and analyzed using SPSS version 20.0. Delay was analyzed at three levels (patient, health system and total) using median as cut-off. Logistic regression analysis was performed to investigate predictors of delays. A p-value of ≤0.05 at multivariate analysis was considered statistically significant.ResultsThe median total, patients’ and health system’s delay was 36 [interquartile range (IQR): 24, 64], 30 (IQR: 15, 60) and 6 (IQR: 4, 8) days, respectively. About 41 and 47% of patients had prolonged patients’ and total delay, respectively. Practicing self-medication [adjusted odds ratio (AOR): 3.0; 95% CI: 1.3–5.6], having more than three family member in the household (AOR: 1.6; 95% CI: 1.02–2.50), older age (≥55 years) (AOR: 2.7; 95% CI: 1.27–5.83), being smear negative pulmonary tuberculosis (AOR: 2.3; 95% CI: 1.25–4.21) and extrapulmonary tuberculosis (AOR: 2.3; 95% CI: 1.28–4.07) were independent predictors of patients’ delay. Initial visit of general practitioners (AOR: 2.57; 95% CI: 1.43–4.63) and more than one health care visit (AOR: 2.12; 95% CI: 1.30–3.46) were independent predictors of health system’s delay. However, patients’ delay was shorter among widowed/divorced patients (AOR: 0.3; 95% CI: 0.1–0.8). Lower level of education [illiterate (AOR: 0.42; 95% CI: 0.20–0.92), grade 1–8 (AOR: 0.38; 95% CI: 0.18–0.81)] and diagnosis of TB using a chest X-ray (AOR, 0.32; 95% CI, 0.16–0.68) significantly reduce health system’s delay.ConclusionAbout half of TB patients delayed beyond 36 days before starting treatment, and the late patient health seeking behavior was the major contributor of total delay. Development and implementation of strategies aimed at addressing identified factors should be recognized in order to reduce TB treatment delay. Further well designed research is needed to explore additional risk factors of delayed treatment.
Highlights
Delayed treatment of tuberculosis (TB) cases increases the risk of death and rate of infection in the community
Different factors contributing for delayed treatment of TB patients have been assessed across the globe and broadly classified as factors associated to patient, health care provider or a combination of the two [7,8,9,10]
Study participant sociodemographic characteristics During the study period 390 TB patients were enrolled from randomly selected 15 directly observed treatment short course (DOTS) providing public health facilities, but 8 patients were excluded from analysis due to incomplete information on TB registration books and questionnaire
Summary
Delayed treatment of tuberculosis (TB) cases increases the risk of death and rate of infection in the community. Effective TB control depends on major improvement in TB prevention and care strategies in these high burden countries including Ethiopia [1]. Early diagnosis of infectious TB cases and treating them effectively are the keystones of global TB control programs [3]. Late diagnosis and treatment of TB cases have been identified as a major obstacle of TB control program especially in low income countries like Ethiopia. Prolonged treatment delay increases the risk of spreading infection and out-of-pocket expenditure of patients in the community, limits the success of TB treatment and is accompanied by a high risk of morbidity and mortality [4,5,6]. Different factors contributing for delayed treatment of TB patients have been assessed across the globe and broadly classified as factors associated to patient, health care provider or a combination of the two [7,8,9,10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
