Abstract
BackgroundDelayed presentation of pulmonary TB (PTB) patients for treatment from onset of symptoms remains a threat to controlling individual disease progression and TB transmission in the community. Currently, there is insufficient information about treatment delays in Zimbabwe, and we therefore determined the extent of patient and health systems delays and their associated factors in patients with microbiologically confirmed PTB.MethodsA structured questionnaire was administered at 47 randomly selected health facilities in Zimbabwe by trained health workers to all patients aged ≥18 years with microbiologically confirmed PTB who were started on TB treatment and entered in the health facility TB registers between 01 January and 31 March 2013. Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) for associations between patient/health system characteristics and patient delay >30 days or health system delay >4 days.ResultsOf the 383 recruited patients, 211(55%) were male with an overall median age of 34 years (IQR, 28-43). There was a median of 28 days (IQR, 21-63) for patient delays and 2 days (IQR, 1-5) for health system delays with 184 (48%) and 118 (31%) TB patients experiencing health system delays >30 days and health system delays >4 days respectively. Starting TB treatment at rural primary healthcare vs district/mission facilities [aOR 2.70, 95% CI 1.27-5.75, p = 0.01] and taking self-medication [aOR 2.33, 95% CI 1.23-4.43, p = 0.01] were associated with encountering patient delays. Associated with health system delays were accessing treatment from lower level facilities [aOR 2.67, 95% CI 1.18-6.07, p = 0.019], having a Gene Xpert TB diagnosis [aOR 0.21, 95% CI 0.07-0.66, p = 0.008] and >4 health facility visits prior to TB diagnosis [(aOR) 3.34, 95% CI 1.11-10.03, p = 0.045].ConclusionPatient delays were longer and more prevalent, suggesting the need for strategies aimed at promoting timely seeking of appropriate medical consultation among presumptive TB patients. Health system delays were uncommon, suggesting a fairly efficient response to microbiologically confirmed PTB cases. Identified risk factors should be explored further and specific strategies aimed at addressing these factors should be identified in order to lessen patient and health system delays.
Highlights
Delayed presentation of pulmonary TB (PTB) patients for treatment from onset of symptoms remains a threat to controlling individual disease progression and TB transmission in the community
Patient characteristics During the 3-month study period, all 383 interviewed patients gave voluntary consent to participate in the survey of whom the majority, 211 (55%) were male (Table 1)
Patient delays and associated factors There was a median of 28 days for patient delays (IQR, 21-63)
Summary
Delayed presentation of pulmonary TB (PTB) patients for treatment from onset of symptoms remains a threat to controlling individual disease progression and TB transmission in the community. There is insufficient information about treatment delays in Zimbabwe, and we determined the extent of patient and health systems delays and their associated factors in patients with microbiologically confirmed PTB. The continued spread of TB can partly be attributed to delayed or undiagnosed TB and this in turn has been shown to be associated with increased mortality [3]. The high burden of HIV co-infection results in a rapid increase in the number of tuberculosis patients in the community [4]. Zimbabwe has a high burden of TB/HIV co-infection, which was recorded at 69% in 2013 [1]. In 2013 prevalence estimates of TB morbidity (including HIV/TB co-infections) were 409 (235-630) cases per 100,000 population whilst mortality estimates (including HIV/TB deaths) were 153 (121-189) cases per 100,000 population [1]
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