Delay In Seeking Treatment Research Articles

Profile Of Infectious Complications in Pediatric Oncology Patients: Experience from Tertiary Referral Hospital in Low and Middle-Income Country

Abstract Background Cancer patients are at higher risk of infections and more likely to have higher morbidity and mortality than the general population, While cancer itself is still the main cause of death in children around the world, in countries with limited health facilities, that might cause delay in seeking treatment, cancer death rate in children could reach 90%; most of them are caused by infectious complications such as typhilitis and mucositis, and febrile neutropenia might contribute to it. The aim of the study was to describe that infectious complications that occur in pediatric oncology patients does correlate with febrile neutropenia and prognosis. Methods We collected data using Hospital Information System from October 1, 2022, to October 31, 2023, in pediatric oncology patients aged 1 to 18 years admitted to Hasan Sadikin General Hospital. Data collected included patient characteristics, diagnosis, typhlitis and mucositis, and neutropenia. Mortality data were also collected after auditing by experts from Hasan Sadikin General Hospital. Results There were 1982 pediatric oncology patients admitted, 90 (4,5%) were consulted to infectious diseases because of neutropenia; most of these patients (34.4%) were diagnosed with acute myeloblastic leukemia, with acute lymphoblastic leukemia second (24,4%). Most of the patients were <5 years old (42,25%); 77/90 (85,5%) had ANC<500 and most were categorized as high-risk group 62/77 (80,5%). Mucositis and typhlitis occurred more commonly in this group with 17/67 (25,3%) and 2/67 (2,9 %) respectively compared to 3 cases of mucositis and no case of typhlitis in the low-risk group. Mortality rate was 10,4% (7/67) in the high-risk group, and all of them had mucositis and/or typhlitis. Conclusion Better quality of care including infection prevention and control is important, especially in high-risk group population with low ANC because infectious complications such as typhlitis and mucositis are much likely to occur and could affect prognosis.

Influence of Health-Seeking Behavior on Treatment Initiation of Cancer Patients at a Tertiary Care Hospital in Varanasi

Abstract Background: Cancer is one of the leading causes of death worldwide, and in order to prevent it, it is vital to understand cancer patients’ health-seeking behavior that contributes to patient delays in receiving cancer treatment globally; however, no similar studies have been conducted in India. Therefore, this study made an effort to know health-seeking behavior among delayed cancer patients receiving treatment at a tertiary care hospital, Varanasi. Methods: A cross-sectional study was conducted at the Department of Surgical Oncology OPD, Sir Sunder Lal Hospital, IMS, BHU, Varanasi. Randomly selected 440 registered patients were interviewed with the help of semi-structured questionnaire. Binary logistic regression analysis and 2-test were used in this study. Results: Out of total 440 patients included in this study, 207 (47.05%) were males and 233 (52.95%) were females. The majority (59.32%) of patients were more than 45 years of age group. Most (80%) of the patients had delay in cancer treatment of more than 60 days from onset of symptoms. Only 29.55% of patients were aware of any symptoms of Cancer. Those patients who were doing self-medication (P=0.03) and did not attend any cancer screening program (P=0.04) showed a statistically significant association with delayed initiation of treatment. Patients referred from another centre (P = 0.03) also show a significant association with delayed treatment initiation. Cancer patients who visited the screening program (AOR= 0.22, P=0.003) were significantly associated with a lower likelihood of delayed treatment initiation. Conclusion: The study showed that 80% of patients were delayed in seeking treatment for Cancer and highly influenced by low awareness, self-medication and visiting multiple health centres for diagnosis and treatment. Therefore, there is a strong need to address the reasons for the delay in seeking treatment.

Case Report: An Integrated Approach To Treating Infected Corneal Laceration With Traumatic Endophthalmitis In Paediatric Age Group

This case report presents a case of infected corneal laceration with traumatic endophthalmitis in a pediatric patient. A boy in his middle childhood sustained an ocular injury with scissors, resulting in a full-thickness corneal laceration and infection. Despite the delay in seeking treatment, the patient underwent successful surgical interventions, including corneal scraping, pars plana lensectomy, vitrectomy, and secondary intraocular lens implantation (IOL). The infection was managed with targeted antibiotics, and Staphylococcus aureus was confirmed as the causative organism. Remarkably, these efforts led to a satisfactory improvement in the patient’s vision to 20/50. This case underscores the importance of early intervention and a multidisciplinary approach in the management of pediatric ocular trauma to optimize outcomes.

Prehospital treatment-seeking for acute coronary syndrome in culturally and linguistically diverse immigrant populations: a scoping review.

Studies consistently report longer prehospital delays in culturally and linguistically diverse (CALD) patients experiencing acute coronary syndrome (ACS). A scoping review was conducted to describe terms and methods used to define and identify CALD populations and summarise available evidence on factors related to prehospital delays in ACS studies involving CALD populations. We searched six electronic databases for published studies and Google Scholar for grey literature to identify studies on prehospital treatment-seeking in CALD immigrants experiencing ACS. We followed the Joanna Briggs Institute methodological framework for scoping review. Twenty-three studies met our eligibility criteria (quantitative n=17; qualitative n=6; mixed n=1). Terms like ethnicity, migrant or expatriate defined CALD populations. Most studies used a single indicator (e.g., country of birth) to identify CALD cohorts, and only two studies used a theoretical model related to treatment-seeking delays to guide data collection. Most factors affecting prehospital delays in CALD populations were similar to those reported in general populations. A unique finding was a difference in the language used to describe symptoms, which, when translated, changes their meaning and resulted in misinterpretation by healthcare providers (e.g., asfixiarse [translates as asphyxiate/suffocate] used for dyspnoea/shortness of breath in Hispanics). Terms and methods used for defining and identifying CALD populations are inconsistent. Studies on factors affecting prehospital treatment-seeking in CALD ACS patients are limited. Future studies should use theoretical models related to treatment-seeking delays to comprehensively explore factors affecting prehospital delays. Additionally, researchers should consider self-reported or multiple indicators to determine CALD status.

Predictors of delayed health seeking for febrile children: multi-level analysis of cross-sectional study data from southern Ethiopia.

Febrile illnesses are commonly reported as a primary reason for seeking healthcare in sub-Saharan Africa. Timely diagnosis and getting prompt treatment within 24 h of fever onset is crucial to avert the risk of developing severe complications and death. Understanding factors contributing to delayed health seeking is important for public health interventions. Hence, this study aimed to assess individual- and contextual-level factors associated with the delay in seeking prompt treatment for children with fever. A community-based cross-sectional study was conducted from September 2022 to June 2023 in Gamo zone, southern Ethiopia. Three districts were chosen, and then, from each district, six clusters or kebeles were chosen by simple random sampling. A total of 820 caregivers were randomly selected. A two-level mixed-effects logistic regression model was employed to identify factors associated with the delay in seeking prompt treatment. The associations were measured by an adjusted odds ratio (AOR), and statistical significance was declared at a 5% level of significance. The prevalence of the delay in seeking prompt care was 47.8%. Factors contributing to the delay were caregivers who were aged 30 years and above [AOR 0.23, 95% confidence interval (CI): 0.10-0.52], caregivers who followed the Protestant religion (AOR 3.67, 95% CI: 2.08-6.48), caregivers unable to read and write (AOR 5.32, 95% CI: 6.80-11.70), merchant caregivers (AOR 6.63, 95% CI: 2.75-15.97), caregivers who were exposed to only one media source (AOR 9.3, 95% CI: 8.43-15.60), caregivers with the experience of child death (AOR 0.05, 95% CI: 0.01-0.22), and caregivers seeking permission from their partners to access healthcare (AOR 12.64, 95% CI: 6.98-22.89). There was a high level of delay in seeking healthcare. Targeted community education through mass media, healthcare facilities, and community-level awareness campaigns should be strengthened to improve early treatment seeking and lessen the consequences of delayed treatment seeking.

Predictors of Morbidity and Mortality of Gastrointestinal Perforation in Children

Background: Gastrointestinal perforation is a common surgical problem in paediatric surgical ward in our country. It carries a high morbidity and mortality in children. The predictors of postoperative morbidity and mortality are still not well established. Objectives: The objective of this study was to identify the predictors of morbidity and mortality following surgery for gastrointestinal perforation in children. Methods: This was a single centre cross sectional type of descriptive observational study carried out in the Department of Paediatric Surgery, Mymensingh Medical College Hospital with 16-month duration from 1st January, 2017 to April 30, 2018, in children aged from 2-12 years. Predictors related to postoperative morbidity and mortality were investigated. Results: A total of 40 patients were selected for this study with mean age of 8.92±2.61 years. Male: female was 1.5:1. Analysis indicated that factors associated with postoperative morbidity and mortality were low BMI, poor nutritional status, low serum total protein and albumin, delay in seeking treatment and contaminated peritoneal collection. Appendicular perforation was the highest number perforation in 23(57.5%) patients. Ileal perforation was the second highest number 8(20%). Appendectomy was the highest surgical procedure 21(52.5%), followed by resection-anastomosis and wound excision & repair 3(7.5%) each. Serum total protein and albumin were below normal limit among 15(37.5%) and 35(87.5%) patients respectively. 13(32.5%) patients received treatment 72 hours after onset of symptom and 18(45%) patients undergone operation within 24-48 hours of admission. Postoperative complications developed in 30 patients. Among them SSI were in 20(66.66%), SIRS in 9(30%) and leakage of repair in 1(3.33%) patient. Mortality rate was 5%. Conclusion: Poor nutritional status, low total serum protein and albumin, delay in initiation of treatment, and contaminated peritoneal fluid are the predictors of morbidity and mortality of gastrointestinal perforation in children.

Modified Pneumatic Reduction Protocol for Intussusception: A Retrospective Cohort Study in an Ultrahigh Volume Center

BackgroundThis study aims to assess the long-term outcomes of a modified pneumatic reduction protocol for intussusception at the Vietnam National Hospital of Pediatrics, an institution with a significant patient load in a lower-middle-income country. Patients and methodsA single center, retrospective cohort observational study was conducted to examine patients who underwent modified fluoroscopic-guided air-enema reduction (FGAR) for intussusception from January 2016 to December 2017. Data on patient demographics, complication rates, and the incidence of long-term recurrence was collected. ResultsBetween January 2016 and December 2017, a total of 3562 patients underwent modified FGAR at our institution, including 2313 males (64.9%) and 1249 females (35.1%). The median age was 19 months (range: 1–170), and the median FGAR procedure duration was 4 min (range: 2–24). The median hospital stay was 1 day (range: 1–31). Successful reduction was achieved in 98.7% of cases, with 43 unsuccessful cases and 4 cases of perforated bowel requiring surgery. Twenty patients, presenting with severe symptoms due to delayed treatment seeking, were admitted to the pediatric intensive care unit (ICU) post-FGAR. No mortality or severe morbidity was reported. Over a median 6-year follow-up, intussusception recurred in 198 patients, accounting for 5.6% of the cohort, with 97% of recurrences occurring within the first year post-reduction. Infants and children under 12 months of age had the highest complication rates, including failed FGAR, complicated intussusception, ICU admission, or recurrence, compared to other age groups, and this difference was statistically significant (p < 0.05). ConclusionThe modified FGAR protocol has been demonstrated to be safe and feasible, with a very high success rate, low complication rate, and low recurrence rate. Although further comparative studies are needed to confirm its reproducibility, it should be considered a promising approach for children in low-to middle-income countries. Level of EvidenceLevel III.

Physical Heart Failure Symptom Clusters Predictive of Delay in Seeking Treatment.

Recent research has focused on the relationship between heart failure (HF) symptom clusters and outcomes, including mortality, hospitalization, functional status, and quality of life. No known studies to date have explored the role of physical HF symptom clusters and delays in seeking treatment. Describe physical symptom clusters in a population of HF patients and determine if a specific cluster is predictive of delay in seeking treatment for HF symptoms. We analyzed combined data from two studies (n = 406) collected during acute HF hospitalization. The Heart Failure Somatic Awareness Scale quantified physical HF symptoms. Delay, measured in days, was collected from the medical record and confirmed by interview. Hierarchical agglomerative clustering techniques determined physical HF symptom clusters. Hierarchical multiple regression analysis was computed to explore predictors of delay. Participants were primarily White, male sex older adults. Three physical HF symptom clusters were identified: discordant, edema-related symptoms, and dyspnea-related symptoms. Hierarchical multiple regression analysis revealed in Step 1 that age was a significant predictor of delay. Our findings provide valuable insight into the role of physical symptom clusters on delay in persons with HF. Through agglomerative hierarchical clustering techniques, we found three physical HF symptom clusters that were then used to determine differences in cluster membership by demographic and clinical variables. Significant age differences were noted by cluster membership with youngest older adults in a discordant symptom cluster.

Why are You Late? A Descriptive Study of Delay in Treatment Seeking among Patients of Carcinoma Breast Presenting to a Tertiary Care Hospital in South India

Objectives: The objectives of this study were as follows: Primary: To estimate the proportion of breast cancer patients with delay in presentation. Secondary: To assess the reasons for delay in presentation among patients with breast cancer. To identify the sociodemographic and clinical characteristics associated with delayed presentation among patients with breast cancer. Materials and Methods: We conducted a hospital-based descriptive study at a tertiary care hospital- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), from a period of January 2016 to June 2016. The participants were interviewed at the time of their hospital visit with a standardised questionnaire after obtaining informed consent. The patients were asked to recall the time interval between the first recognition of symptoms and the first medical consultation. A duration of &gt;3 months was considered a patient delay. The patient reported the first symptom, and the symptoms at presentation were noted. Through clinical examination of the breasts, axilla and other systems was performed, and the positive clinical features were recorded. Results: A total of 126 women were included in the study. Out of 126 patients, 37 patients (29.4%) presented to healthcare personnel within 3 months of identifying their symptoms, and 89 patients (70.6%) presented later than 3 months. The mean duration of delay is 171.5 days, with a standard deviation of 229.45 and a median delay being 120 days. The most common cause for delay was due to the patient’s perception that the lump was harmless or temporary. The average time taken by the patients to present to JIPMER for definitive management of breast cancer after visiting a local physician was a median of 25 days and a mean of 48.77 days. The time taken for confirmation of diagnosis from the time of presentation to JIPMER was a median duration of 13 days and a mean duration of 16.58 days with a standard deviation of 12.31. About 90% of the patients had their diagnosis confirmed within 1 month. Conclusion: In our study, the proportion of delayed presentation among breast cancer patients was found to be 70.6%. Patients from rural areas and with lower educational status were found to have a higher incidence of delayed presentation. Lack of awareness of breast cancer symptoms and their misinterpretation as harmless, temporary and benign are the main reasons for delayed presentation. Patients who practised breast self-examination presented earlier. Further studies with a larger sample will help in identifying the other sociodemographic and clinical characteristics responsible for delayed presentation.

It's not just a movie: Perceived impact of misportrayals of dissociative identity disorder in the media on self and treatment

BackgroundHollywood has demonstrated an interest in dissociative identity disorder (DID), but unfortunately, films and television series have portrayed DID in captivating storylines at the expense of individuals living with DID. These representations of DID are often stigmatizing, stereotypical, and inaccurate. ObjectiveThe present study aimed to explore the impact of media portrayals on patients’ views of themselves and their treatment. MethodA total of 377 individuals with DID completed an online survey about their perceptions of the impact of DID representations in the media, and 151 of those participants reported that media portrayals of DID had an impact on their mental health treatment. Reflexive thematic analysis was used to analyze qualitative data. ResultsOf those participants who reported an impact on their treatment, an overwhelming majority (n = 129) reported the impact to be negative. Five superordinate themes emerged: 1.) portrayals are inaccurate and perpetuate myths among clinicians, 2.) portrayals impact patients’ experiences of themselves and access to treatment, 3.) lack of clinical training and influence of media portrayals lead to negative outcomes, 4.) portrayals lead to maltreatment by clinicians, and 5.) importance of specialty treatment not based on media portrayals. ConclusionsThe present study found that inaccurate, stigmatizing media depictions of DID perpetuate misconceptions about DID and contribute to delays in seeking treatment and getting accurately diagnosed, and increased shame and self-loathing among individuals with DID.

Number of comorbidities and the risk of delay in seeking treatment for coronary heart disease: a longitudinal study in Bogor City, Indonesia.

The aim of this study was to investigate the relationship between the number of patient comorbidities and the delays in seeking treatment for coronary heart disease (CHD). This longitudinal study utilized secondary data from the Non-Communicable Disease Risk Factor (NCDRF) cohort study conducted in Bogor City. Individuals who participated in the NCDRF cohort study and were diagnosed with CHD within the 6-year study period met the inclusion criteria. Respondents who were not continuously monitored up to the 6th year were excluded. The final sample included data from respondents with CHD who participated in the NCDRF cohort study and were monitored for the full 6-year duration. The final logistic regression analysis was conducted on data collected from 812 participants. Among the participants with CHD, 702 out of 812 exhibited a delay in seeking treatment. The risk of a delay in seeking treatment was significantly higher among individuals without comorbidities, with an odds ratio (OR) of 3.5 (95% confidence interval [CI], 1.735-7.036; p<0.001). Among those with a single comorbidity, the risk of delay in seeking treatment was still notable (OR, 2.6; 95% CI, 1.259-5.418; p=0.010) when compared to those with 2 or more comorbidities. These odds were adjusted for age, sex, education level, and health insurance status. The proportion of patients with CHD who delayed seeking treatment was high, particularly among individuals with no comorbidities. Low levels of comorbidity also appeared to correlate with a greater tendency to delay in seeking treatment.

Women Acute Myocardial Infarction-Identifying and Understanding the Gender Gap (WAMy-GAP): A Study Protocol.

Barriers to accessing care and misinterpretations of ischemic heart disease symptoms due to lack of awareness contribute to women's delay in seeking care. Women may delay seeking treatment for up to 3 h or even up to 5 days. They often perceive themselves to be at low risk of cardiovascular disease (CVD) and prioritize family responsibilities or household chores. The causes of this delay are multifactorial and influence the decision-making process, particularly in the pre-hospital phase. The objective of this study protocol is to evaluate prodromal symptoms and identify risk behaviors in women with acute myocardial infarction (AMI). This is a protocol for a multicenter study that will be conducted using the mixed-method methodology using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) to evaluate symptoms and semi-structured interviews to investigate behaviors. This study protocol is intended to fill an important knowledge gap on premonitory and acute symptoms of AMI in women in Italy, as well as to understand the causes and mechanisms underlying delays in accessing healthcare services during an acute event such as AMI. The investigation of this issue will facilitate the removal of gender-related inequalities in the diagnosis and treatment of acute myocardial infarction while also fostering dialogue on the barriers to behavior change.

Reasons for Delay in Fungating Breast Cancer Presentation at a Tertiary Care Facility of Pakistan

Background and objective: Breast cancer is a treatable disease resulting in complete cure. Late presentation is not uncommon in third world countries. The factors leading to delay in reporting to the hospital must be studied. The objective of this research was to identify the factors responsible for late presentation of fungating breast cancer patients at a tertiary care hospital of Pakistan.Methods: It was a descriptive, cross-sectional study conducted at Jinnah hospital Lahore from January 2020 to December 2022. A total of 56 respondents were selected through non-probability purposive sampling technique. A pre-tested structured questionnaire was administered, data were gathered after taking informed consent and data confidentiality was ensured. The collected data were analyzed using SPSS version 23. The stage 1 and 2 carcinoma breast patients are excluded from the study. The sample size was calculated by using WHO calculator.Results: A total of 56 cases of fungating breast growths were included in the present study carried out for a period of two years. Among 56 cases the mean age of patients was 45+9 years. The study found that the reasons leading for the delay in seeking treatment were poor socioeconomic status, belief in traditional faith healers, cultural myths, reliance on alternative medicine, fear of medical procedures, resistance from family members, and lack of accessibility.Conclusion: The delayed presentation of breast cancer leading to fungating growth is a significant concern that needs to be addressed. By identifying the reasons for delayed presentation, healthcare providers and policymakers can develop targeted interventions to improve early detection and prompt treatment, eventually improving the prognosis and quality of life of breast cancer patients.Key Words: delayed presentation, fungating breast cancer, reasons, tertiary care facility.

Treatment seeking experiences of ACS patients in Yogyakarta, Indonesia during COVID-19 pandemic: A qualitative study.

Delay in treatment seeking is recognized as a major contributor for Acute Coronary Syndrome (ACS) mortality in Indonesia. Despite the significance of timely treatment, decline in admission and delay in presentation of patients with ACS were consistently reported during the COVID-19 pandemic. These suggested that treatment seeking performance of patients during the pandemic might be different from the previous period. This qualitative study aimed to explore treatment seeking behaviour, barriers in seeking medical treatment, and experiences of patients with ACS in Yogyakarta, Indonesia during COVID-19 pandemic. In depth-interviews were carried out with 30 patients, who were hospitalized with ACS at one of the three selected hospitals in Yogyakarta during the pandemic period. Thematic analysis was performed to create vital explanations for treatment seeking practices of patients with ACS during pandemic. Three significant themes were identified: treatment seeking decisions, barriers in seeking medical treatment during COVID-19, and experiencing both good and bad impression from entering and staying in the hospital. The intensity of ACS symptoms and fear of COVID-19 infection dominated the delay in seeking medical treatment. Strict safety measures, religious belief, and fear of ACS helped patients overcome barriers and seek medical treatment during pandemic. ACS patients also had convenient medical care during the pandemic and believed medical staff would provide excellent care to them. However, visit restriction policy could cause psychological discomfort. Increase awareness of ACS symptoms and the risk of delays ACS treatment are essential to support patients' decisions to seek medical helps in a timely manner at any situations including pandemic. Interventions aim at alleviating psychological distress should also be designed and implemented to improve treatment experiences of ACS patients, who sought medical treatment during the pandemic crisis.

Perceptions of Delay in Seeking Medical Help among People with Diabetic Foot Ulcers in Rural Southwest China

Diabetic foot infection is one of the most severe complications of diabetes mellitus. Immediately seeking medical attention is vital after foot ulcers occur; however there are often delays in seeking treatment. This study used a qualitative descriptive approach to explore the perceptions of delay in people seeking medical help for foot ulcers in three villages in Baise, rural areas of southwest China. Fifteen patients were recruited in this study. In-depth interviews were performed to collect data from August to October 2022, and thematic analysis was used to analyze the data. This study identified four main themes: personal estimation; supernatural and traditional power; health service expertise, cost and access to hospital care; and psychological and complementary care. Inadequate awareness of potential ulcers and a preference for alternative methods significantly contributed to delays in medical foot care. Additionally, a shortage in community healthcare services impeded the timely initiation of proper foot care actions. It was worth noting that the preference for Traditional Chinese Therapy was relevant to the delay in seeking medical attention on foot, yet it was not perceived before. These findings serve as crucial evidence for developing interventions and future policy adjustments. Further consideration of the multifaceted impacts is necessary to incentivize prompt treatment decisions for diabetic foot ulcers. Nurse specialists should be concerned regarding psychological care, and dual-way support between nurses and families is vital for prompt medical care-seeking. Nursing education should emphasize knowledge of pathophysiology integrating prayer merits and Chinese therapies for patient empowerment.

Prevalence of delayed treatment for sexually transmitted infections and its determinants in sub-Saharan Africa. A systematic review and meta-analysis.

Sexually transmitted infection is a common public health issue, and it is characteristically transmitted through sexual intercourse. Around the globe, particularly in less developed countries, delayed treatment of this infection could lead to a health and economic burden. Even though the health and economic burden of sexually transmitted infections is high, studies to identify the pooled proportion and the possible factor of delayed treatment seeking are rare in sub-Saharan African countries. To assess the prevalence of delayed treatment for STIs and its determinants in sub-Saharan African countries. Articles searched on search engines like Medline via PubMed, HINARI, Embase, Scopus, Cochrane Library, Science Direct, and websites like Google Scholar. The searching mechanism was using keywords and medical subject heading terms by combining the key terms of the title. To assure the quality of the included articles, Joana Brigg's Institute critical appraisal checklist was used. To assess the heterogeneity of the studies, a sensitivity analysis was conducted. The PRISMA checklist was used, and to estimate the pooled odds ratio, a random effect model was considered. The pooled odds ratio of 95% CL was used to identify the factors. About 13 studies with 46,722 participants were incorporated. Despite considerable heterogeneity, the pooled prevalence of delayed treatment for STI in Sub-Saharan Africa was 47% (95% CI: 42%-51%, I2 = 98.42, p<0.001). Geographically, the higher pooled prevalence of delayed treatment for STI was in the eastern part of Africa (50%) (95% CI: 41%-59%, I2 = 98.42, p<0.001). Rural residence (OR = 1.44, 95% CI: 1.03-2.01, I2 = 39.3%, p-value = 0.19), poor knowledge about STI (OR = 1.49, 95% CI: 1.04-2.13, I2 = 93.1%, p-value = <0.001), perceived as STIs not serious (OR = 2.1, 95% CI: 1.86-2.36, I2 = 73.7%, p-value = 0.022), misconception for STD cause (OR = 1.39, 95% CI: 1.12-1.72), no education (OR = 4.1, 95% CI: 3.4-5.1), primary education (OR = 3.17, 95% CI: 2.23-4.2), and secondary education (OR = 1.57, 95% CI: 1.1-2.76) as compared to secondary and above education were factors associated with delayed treatment for STIs. The pooled prevalence of delayed treatment for STIs in Sub-Saharan African countries was high. Poor knowledge, attitude, and educational status affect the treatment delay for STIs. Thus, improving knowledge, educational status, and attitude are highly recommended to reduce the delayed treatment of STIs.

Factors influencing delay in malaria treatment seeking at selected public health facilities in South Gonder, Ethiopia

Early and prompt treatment-seeking for malaria is necessary to reduce the progression of the disease to its severe forms and the associated mortality. Various studies have indicated that treatments sought for malaria were not always within the recommended timeframe. Therefore, this study aims to assess factors influencing delay in malaria treatment seeking at public health facilities in South Gonder, Ethiopia. An unmatched case–control study was conducted among 322 individuals, comprising 161 cases and 161 controls, who were randomly selected malaria patients visiting public health facilities in South Gonder District, Ethiopia, from May 20/2022 to June 25/2022. An interviewer-administered questionnaire was used to collect data, which were subsequently cleaned and entered into Epi data. Descriptive statistics were performed, and variables with a p-value of ≤ 0.25 from the bivariate analysis were included in a multivariable logistic regression model. Significant variables with a p-value of < 0.05 were retained in the multivariable model. Patients who were unable to read and write [AOR = 3.47 (1.01–11.9)], fear of side effects of malaria treatment drugs [AOR = 1.89 (1.04–3.42)], lack of access to health education malaria disease and its treatment [AOR = 1.93 (1.02–3.65)], lack of transportation access [AOR = 4.70 (1.73–12.7)], not membership of community-based health insurance [AOR = 2.5 (1.3–4.82)] and lack of confidence on malaria care health facility providing [AOR = 2.14 (1.06–4.29)], were found to be determinants of treatment-seeking delay among malaria patients. In Summary, this study revealed significant associations between delays in seeking malaria treatment and factors such as educational status (those who were unable to read and write), malaria drug side effects, health education on malaria, transportation access, CBHI membership, and confidence in health malaria care. it is recommended that targeted interventions and awareness campaigns be implemented to address these determinants, promoting prompt and effective malaria treatment-seeking behavior in the studied population.

Factors affecting delays in seeking treatment among malaria patients during the pre-certification phase in China

BackgroundDelays in malaria treatment can not only lead to severe and even life-threatening complications, but also foster transmission, putting more people at risk of infection. This study aimed to investigate the factors influencing treatment delays among malaria patients and their health-seeking behaviour.MethodsThe medical records of 494 patients diagnosed with malaria from 6 different malaria-endemic provinces in China were analysed. A bivariate and multivariable regression model was used to investigate the association between delays in seeking treatment and various factors. A Sankey diagram was used to visualize the trajectories of malaria patients seeking medical care. Total treatment delays were categorized as patient delays and doctor delays.ResultsThe incidence of total delays in seeking malaria treatment was 81.6%, of which 28.4% were delayed by patients alone and 34.8% by doctors alone. The median time from the onset of symptoms to the initial healthcare consultation was 1 day. The median time from the initial healthcare consultation to the conclusive diagnosis was 2 day. After being subjected to multiple logistic regression analysis, living in central China was less likely to experience patient delays (OR = 0.43, 95% CI 0.24–0.78). The factors significantly associated with the lower likelihood of doctor delays included: age between 30 to 49 (OR = 0.43, 95% CI 0.23–0.81), being single/divorce/separated (OR = 0.48, 95% CI 0.24–0.95), first visiting a county-level health institution (OR = 0.25, 95% CI 0.14–0.45), first visiting a prefectural health institution (OR = 0.06, 95% CI 0.03–0.12) and first visiting a provincial health institution (OR = 0.05, 95%CI 0.02–0.12). Conversely, individuals with mixed infections (OR = 2.04, 95% CI 1.02–4.08) and those experiencing periodic symptoms (OR = 1.71, 95% CI 1.00–2.92) might face increased doctor delays. Furthermore, higher financial burden and complications were found to be associated with patient delays. Doctor delays, in addition to incurring these two consequences, were associated with longer hospital stays.ConclusionThere was a substantial delay in access to health care for malaria patients before China was certified malaria free. Region, marital status, periodic symptoms and the level of health institutions were factors contributing to delays in treatment-seeking among malaria patients.

Delay in seeking treatment and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel zone, Benishangul Gumuz region, Western Ethiopia.

Tuberculosis is a major global public health problem and a leading cause of morbidity and mortality in Ethiopia. TB prevention and control in low-income countries, such as Ethiopia, face significant challenges, including late detection and treatment initiation. A delay in the initiation of tuberculosis treatment increases the morbidity and mortality of patients and community transmission. Therefore, this study aimed to assess patient delay and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel Zone, Benishangul Gumuz Region, Western Ethiopia. An institution-based cross-sectional study was conducted from March to August 2020 among newly diagnosed pulmonary tuberculosis patients. All pulmonary tuberculosis patients (416) who came to all public health facilities of the Metekel zone for treatment during the period were included. Data were collected through face-to-face interviews using a structured and pretested questionnaire. A multivariable logistic regression was fitted to identify independent factors for delay in seeking treatment among PTB patients. Adjusted odds ratios with 95% CIs were determined, and variables with p values <0.05 were considered statistically significant. Nearly three-fourths 302 (72.6, 95% CI: 68.5, 76.7) of the patients were delayed in seeking medical advice, with a median patient delay of 27 days (IQR: 21-31). Age of the patients [above 54 years (AOR = 2.65, 95% CI: 1.30, 5.40), 36-54 years (AOR = 1.86, 95% CI: 1.14,3.02)], family size of 5 members and above (AOR = 1.62, 95% CI: 1.10-3.14), travel time above 60 min (AOR = 3.65, 95% CI: 1.55, 8.60), history of visits to informal care providers (AOR = 1.74, 95% CI: 1.11, 3.14), and poor knowledge about PTB (AOR = 1.64, 95% CI: 1.04-2.44) were statistically significant factors associated with delays in seeking treatment among PTB patients. Most pulmonary tuberculosis patients delay seeking medical advice for their illnesses. Delays in seeking treatment were associated with older age, large household size, longer travel time to reach the nearby health facility, visiting informal care providers, and poor knowledge about pulmonary tuberculosis. Hence, it is crucial to consider community screening programs, enhance public awareness, and ensure the accessibility of TB diagnostic and treatment services.

Rapid outpatient transient ischemic attack clinic and stroke service activity during the SARS-CoV-2 pandemic: a multicenter time series analysis.

Rapid outpatient evaluation and treatment of TIA in structured clinics have been shown to reduce stroke recurrence. It is unclear whether short-term downtrends in TIA incidence and admissions have had enduring impact on TIA clinic activity. This study aims to measure the impact of the pandemic on hospitals with rapid TIA clinics. Relevant services were identified by literature search and contacted. Three years of monthly data were requested - a baseline pre-COVID period (April 2018 to March 2020) and an intra-COVID period (April 2020 to March 2021). TIA presentations, ischemic stroke presentations, and reperfusion trends inclusive of IV thrombolysis (IVT) and endovascular thrombectomy (EVT) were recorded. Pandemic impact was measured with interrupted time series analysis, a segmented regression approach to test an effect of an intervention on a time-dependent outcome using a defined impact model. Six centers provided data for a total of 6,231 TIA and 13,191 ischemic stroke presentations from Australia (52.1%), Canada (35.0%), Italy (7.6%), and England (5.4%). TIA clinic volumes remained constant during the pandemic (2.9, 95% CI -1.8 to 7.6, p = 0.24), as did ischemic stroke (2.9, 95% CI -7.8 to 1.9, p = 0.25), IVT (-14.3, 95% CI -36.7, 6.1, p < 0.01), and EVT (0, 95% CI -16.9 to 16.9, p = 0.98) counts. Proportion of ischemic strokes requiring IVT decreased from 13.2 to 11.4% (p < 0.05), but those requiring EVT did not change (16.0 to 16.7%, p = 0.33). This suggests that the pandemic has not had an enduring effect on TIA clinic or stroke service activity for these centers. Furthermore, the disproportionate decrease in IVT suggests that patients may be presenting outside the IVT window during the pandemic - delays in seeking treatment in this group could be the target for public health intervention.