Abstract
BackgroundTuberculosis (TB) control remains a challenge in Malawi despite the National TB Control Program since 1984. This study aimed at measuring patient and health system delays and identifying factors associated with these delays.MethodsA cross-sectional survey of 588 pulmonary TB patients was conducted in three TB centres in Blantyre, Lilongwe, and Mzuzu, between July and December 2011 using a semi-structured questionnaire. Patient delay was defined as the time interval between the onset of TB symptom(s) (a common symptom being coughing) to the first visit to any health provider. Health system delay was the interval from the first care-seeking visit at any health provider to the initiation of anti-tuberculosis treatment. Participants were invited to participate in the study during intensive phase of treatment. The characteristics associated with patient and health system delays were analyzed.ResultsThe median patient delay was 14 days for both new and retreatment TB cases (interquartile range [IQR] 14 – 28 and 7 – 21, respectively). The median health system delay was 59 days (IQR 26 – 108) for new and 40.5 days (IQR 21–90) for retreatment cases. Factors associated with longer patient delay in new cases included primary education (adjusted odds ratio [AOR] 2.2, 95% CI 1.3 – 3.9) and knowledge that more than three weeks of coughing is a sign of TB (AOR 1.9, 1.1 – 3.3). In retreatment cases, distance >10 Km (AOR 3.3, 1.1 – 9.6) and knowledge that more than three weeks of coughing is a sign of TB (AOR 3.7, 1.3 – 10.7; p < 0.05) were significant factors. Making the first visit to a health centre (OR 1.9, 0.9 – 3.8) or a drug store/ traditional healer (OR 5.1, 1.1 – 21.7) in new TB cases were associated with a longer health system delay (p < 0.05) while smear negative (OR 6.4, 1.5 – 28.3), and smear unknown or not done (OR 6.1, 1.3 – 26.9) among retreatment cases were associated with a longer health system delay (p < 0.05).ConclusionsEffective management and new diagnostic techniques are needed especially among retreatment cases. It is also needed to address geographic barriers to accessing care and increasing TB awareness in the community.
Highlights
Tuberculosis (TB) control remains a challenge in Malawi despite the National TB Control Program since 1984
This study aims to measure the extent of and factors associated with patient delay in seeking health care, as well as health system delay in the diagnosis and treatment of new and retreatment TB cases in Malawi
Among patients who had heard of TB before diagnosis, knowledge that more than 3 weeks of coughing is a symptom of TB was significantly associated with patient delay in both new TB case type
Summary
Tuberculosis (TB) control remains a challenge in Malawi despite the National TB Control Program since 1984. Tuberculosis (TB) remains a major health problem despite an increase in coverage of Directly Observed Treatment Short Course (DOTS) therapy and adoption of passive case detection globally. The goal of TB control is to reduce morbidity, mortality, transmission and development of drug resistance. TB control remains a major challenge in Malawi and the sub-Saharan region, which bears the biggest impact of HIV fuelled TB epidemics [1,2]. In Malawi, a total of 21, 092 TB cases were reported in 2010 with a notification rate of 142 per 100, 000 population. The estimated incidence of TB was 219 per 100, 000 population and the estimated case detection rate was 65%. The proportion of TB cases tested positive for HIV was 70% in 2010 [3]
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.
