Patient factors related to pre-treatment delay of pulmonary tuberculosis: A retrospective cohort study in Bangladesh

Abstract

BackgroundBurden of tuberculosis (TB) is still high in Bangladesh. Pre-treatment delay is a hindrance in reducing this burden by early diagnosis and prompt treatment of TB. The study was conducted to identify the patient factors related to pre-treatment delay of pulmonary TB. MethodsThis retrospective cohort study was performed during January to June 2018 in a cohort of 240 consecutively enrolled; newly detected adult pulmonary TB (PTB) patients initiated anti-TB therapy during the study period. Two DOTS were selected randomly using cluster sampling and all the PTB patients enrolled in the DOTS centres formed the study population. Informed written consent was obtained from the patients, prior to data collection. Data were collected by face-to-face interview and reviewing medical records using a semi-structured questionnaire and checklist respectively. ResultsAge of the patients was associated with pre-treatment delay of TB (p < 0.05) with predominance in elderly (75.0%). Delay in care seeking was associated with inability to make decision (RR = 1.84; AR: 35.84%) and awareness of patients (RR = 0.33; AR = −40.0%). Delay in diagnosis was associated with economic problem (RR: 1.63; AR: 28.85%); work barrier (RR: 1.75; AR: 35.03%); inability to make decision (RR: 1.93; AR: 40.65%); delayed investigation (RR: 2.88; AR: 56.17%); others’ assistance (RR: 1.77; AR: 28.53%); and symptomatic treatment (RR: 6.43; AR: 65.14%). Delay in treatment initiation was associated with repeated investigations (RR = 1.52; AR: 23.29%) and smear positivity (RR: 0.64; AR: 23.11%). Awareness of patients regarding symptoms and smear positivity were revealed as protective factors for pre-treatment delay of TB. ConclusionDelay in care seeking, diagnosis, and treatment initiation contribute substantially to pre-treatment delay of PTB. Considerable reduction in pre-treatment delay may be achieved through changes in awareness of patients and ensuring early diagnosis and prompt treatment of PTB under DOTS programme.