Treatment Delay among Smear Positive Pulmonary Tuberculosis Patients in South Ethiopia: A Cross-Sectional Study

Abstract

Background: Most tuberculosis (TB) patients were not visiting heath facility but transmit disease to healthy individuals in the community for longer time in Ethiopia. This study was aimed at estimating duration of delay for initiation of anti-TB treatment by smear positive pulmonary TB in south Ethiopia and assesses its determinants of patient related factors associated with unacceptable delay for medication of TB. Methods: a cross-sectional study design was used to recruit 218 consecutive smear positive pulmonary TB patients visiting there hospitals in Gamo Goffa Zone. A structured questionnaire was used to collect information on socio demographic, economic, behavioral factors and co morbidity with HIV from the study units. The median delay was used as cut-off point to dichotomize acceptable delay from unacceptable one. Pearson chi square and logistic regressions were used to assess association between patient factors and longer delay before treatment. Results: The median delay for initiation of anti-TB medication by smear positive pulmonary TB patients was 35 days. Fifteen of the study participants were HIV positive and equal number of TB patients involved had previous history of TB. Socio-demographic factors significantly associated with longer delay for treatment of TB in Univariate analysis were place of residence, level of education and marital status while economic factors associated were monthly income, whether the house is owned or rented and ceiling status of the house. However, after controlling the effect of confounding variables only place of residence and monthly income remained statistically significant. TB patients from rural area were 2.82 times at increased risk to delay for longer days than those living in the town (p-value= 0.021). Similarly, patients having monthly income of 450 or less Ethiopian birr were 4.96 times more likely to delay for longer time than those who had no regular monthly income (p-value=0.003). Conclusion: Smear positive pulmonary TB patients delay for more days before taking anti-TB medications which renders them noninfectious after a few weeks of treatment began. They were transmitting the disease in the community making prevention and control more difficult. Those living in the rural area and earn least amount of money per month transmit the disease for longer time. Civil servants who earn the least salary per month had significant increment in the salary recently that might prevent their delay. However, access to diagnosis and treatment of TB for people living in the rural area should be improved so as to help the walk towards the millennium development goal targets.