Late Diagnosis and Treatment of Pulmonary Tuberculosis in Ziguinchor, Southern Region of Senegal

Abstract

Background: Untreated smear-positive pulmonary tuberculosis constitutes the main source of transmission of the disease in the community. Aims: The aim of our study was to determine the diagnosis delays of smear-positive pulmonary tuberculosis in adults and to identify the factors associated with the diagnosis delay in Ziguinchor, Senegal. Methodology: This is a prospective descriptive and analytical study carried out from January 1, 2019 to December 31, 2022, in cases of pulmonary tuberculosis whose diagnosis was confirmed by the identification of AFB in sputum after Ziehl Nielsen staining and/or detection of Mycobacterium tuberculosis by Genexpert. Delay was defined as a diagnosis confirmed after 36 days. Logistic regression was performed to determine factors associated with diagnosis delay. Results: A total of 141 patients were included. They had an average age of 40 years ± 16 years, (16 years - 86 years). The peak age group was 16-30 years (34.04%). The sex ratio (M/F) was 1.8. The main characteristics of the patients were: a low level of education (34.8%), work in the informal sector (70.2%) and smoking (25.5%). More than half of the patients (78.44%) had their home less than 5 km from the anti-tuberculosis dispensing center. The patients’ initial symptoms were dominated by cough (90.0%), fever (78%) and weight loss (59.6%). The traditional healer was the first source of care in 40.4%, followed by the health post (37.7%), the health center (16%) and regional hospitals (5.8%). HIV serology was positive in 13.5% of cases. The average time between the beginning of symptoms and the tuberculosis diagnosis was 36± 9.22 days (15 - 58 days). The median time to treatment initiation was 1.8± 1.6 days (1 - 6 days). A diagnosis delay was noted in 53.19%. In multivariate analysis with linear regression, age > 50 years (p = 0.021), use of herbal medicine (p = 0.036) and monthly income < 58 USD (p = 0.039) were the factors associated with late diagnosis of tuberculosis. Conclusion: The diagnostic delay in smear-positive tuberculosis cases is significant in our context. To shorten this mean delay period, it is necessary to both strengthen the professional abilities and skills of caregivers in the health posts and involve after training the traditional healers in the screening and sensitizing process of the population