Abstract
Delayed treatment initiation of Tuberculosis patients results in increased infectivity, poor treatment outcome, and increased mortality. However, there is a paucity of evidence on the delay in new adult pulmonary Tuberculosis patients to initiate treatment in Tigray, Northern Ethiopia. To assess the factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia. The study design was cross-sectional. A total of 875 new adult pulmonary tuberculosis patients were recruited from 21 health facilities from October 2018 to October 2019. Health facilities were selected by simple random sampling technique and tuberculosis cases from the health facilities were consecutively enrolled. Data were collected using structured questionnaire within the first 2 weeks of treatment initiation. Delay was categorized as patient, health system and total delays. Data were analyzed using SPSS version 21 and logistic regression was used to identify factors associated with the odds of delays to initiate treatment. A p-value of less than 0.05 was reported as statistically significant. The median patient, health system and total delays were 30, 18 and 62 days, respectively. Rural residence, being poor, visiting non-formal medication sources, being primary health care and the private clinic had higher odds of patient delay whereas being HIV positive had lower odds of patient delay. Illiteracy, first visit to primary health care and private clinic had higher odds of health system delay whereas a visit to health facility one time and have no patient delay had lower odds of health system delay. The median patient delay was higher than the median health system delay before initiating treatment. Hence, improved awareness of the community and involving the informal medication sources in the tuberculosis pathways would reduce patient delay. Similarly, improved cough screening and diagnostic efficiency of the lower health facilities would shorten health system delay.
Highlights
Tuberculosis (TB), caused by Mycobacterium tuberculosis, is one of the leading causes of morbidity and mortality worldwide and remains a major public health problem in many developing countries [1, 2].Early diagnosis and prompt effective therapy are key elements of successful TB control
The median patient delay was higher than the median health system delay before initiating treatment
The median patient delay was shorter than previous studies in Ethiopia [16, 26, 27] and longer than other reports from Ethiopia [28, 29] and African [3, 30] but the health system delay was shorter than studies in Ethiopia [13, 14] which have similar median patient delay with this study
Summary
Tuberculosis (TB), caused by Mycobacterium tuberculosis, is one of the leading causes of morbidity and mortality worldwide and remains a major public health problem in many developing countries [1, 2].Early diagnosis and prompt effective therapy are key elements of successful TB control. A systematic review reported that the median time of delay from onset of cough until treatment initiation varied from 21–136 days [6]. This could be mainly due to the delay in the pathways of TB treatment such as the time elapsed in seeking health/patient delay or the time elapsed at the health facility due to the failure of the health system to diagnose the disease [7, 8]. Delay in tuberculosis diagnosis may lead to a more advanced disease stage at presentation, which contributes to late sequelae, poor treatment outcome and increased mortality [9, 10]. Delayed treatment initiation of Tuberculosis patients results in increased infectivity, poor treatment outcome, and increased mortality. There is a paucity of evidence on the delay in new adult pulmonary Tuberculosis patients to initiate treatment in Tigray, Northern Ethiopia
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