Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study
Tóm tắt
Delayed diagnosis and treatment of tuberculosis (TB) results in severe disease and a higher mortality. It also leads to an increased period of infectivity in the community. The objective of this study was to determine the length of delays, and analyze the factors affecting the delay from onset of symptoms of pulmonary tuberculosis (PTB) until the commencement of treatment.
In randomly selected TB management units (TBMUs), i.e. government health institutions which have diagnosing and treatment facilities for TB in Amhara Region, we conducted a cross sectional study from September 1-December 31/2003. Delay was analyzed from two perspectives, 1. Period between onset of TB symptoms to first visit to any health provider (health seeking period), and from the first health provider visit to initiation of treatment (health providers' delay), and 2. Period between onset of TB symptoms to first visit to a medical provider (patients' delay), and from this visit to commencement of anti-TB treatment (health systems' delay). Patients were interviewed on the same date of diagnosis using a semi-structured questionnaire. Logistics regression analysis was applied to analyze the risk factors of delays.
A total of 384 new smear positive PTB patients participated in the study. The median total delay was 80 days. The median health-seeking period and health providers' delays were 15 and 61 days, respectively. Conversely, the median patients' and health systems' delays were 30 and 21 days, respectively. Taking medical providers as a reference point, we found that forty eight percent of the subjects delayed for more than one month. Patients' delays were strongly associated with first visit to non-formal health providers and self treatment (P < 0.0001). Prior attendance to a health post/clinic was associated with increased health systems' delay (p < 0.0001).
Delay in the diagnosis and treatment of PTB is unacceptably high in Amhara region. Health providers' and health systems' delays represent the major portion of the total delay. Accessing a simple and rapid diagnostic test for TB at the lowest level of health care facility and encouraging a dialogue among all health providers are imperative interventions.
Từ khóa
Tài liệu tham khảo
World Health Organization: TB as a public health problem. Department of communicable disease. (2 screens). Accessed. January 21/2004, [http://www.whosea.org/tb/publichealth.htm]
Ward HA, Marciniuk DD, Pahwa P, Hoeppner VH: Extent of pulmonary tuberculosis in patients diagnosed by active compared to passive case finding. Int J Tuberc Lung Dis. 2004, 8 (5): 593-597.
Lawn SD, Afful B, Acheampong JW: Pulmonary tuberculosis: Diagnostic delay in Ghanaian adults. Int J Tuberc Lung Dis. 1998, 2 (8): 635-640.
Pirkis JE, Speed BR, Yung AP, Dunt DR, Mac Intyre CR, Plant AJ: Time to initiation of anti-tuberculosis treatment. INT J Tuberc Lung Dis. 1996, 77 (5): 401-406. 10.1016/S0962-8479(96)90111-2.
Steen TW, Mazonde GN: Pulmonary tuberculosis in Kweneng district, Botswana: delays in diagnosis in 212 smear-positive patients. Int J Tuberc Lung Dis. 1998, 2 (8): 627-634.
Wandwalo ER, Morkveø : Delay in tuberculosis case finding and treatment in Mwanza, Tanzania. Int J Tuberc Lung Dis. 2000, 4 (2): 133-138.
Lienhardt C, Rowley J, Manneh K, Lahai G, Needham D, Milligan P, Mc Adam KP: Factors affecting time delay to treatment in a tuberculosis control program in a sub-Saharan African country: the experience of the Gambia. INT J Tuberc Lung Dis. 2001, 5 (3): 233-239.
Ethiopian Ministry of Health: Manual for National Tuberculosis and Leprosy Control Programme. Ministry of Health. 1997
Madebo T, Lindtjørn B: Delay in treatment of pulmonary tuberculosis: an analysis of symptom Duration among Ethiopian patients. Medscape General Medicine. 1999, 1 (1):
Demissie M, Lindtjørn B, Berhane Y: Patients' and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health. 2 (1): 23-10.1186/1471-2458-2-23. 2002 Sep 25
Amhara Regional State Health Bureau: Annual health service report. 2002, Bahirdar: Amhara Regional State Health Bureau
Daniel W: Biostatistics: A foundation for analysis in the health sciences. 1987, New York: John Wiley & Sons Inc, 155-156. 4
Hooi LN: Case finding for pulmonary tuberculosis in Penang. Med J Malaysia. 1994, 49 (3): 223-230.
Sherman LF, Fujiwara PI, Bazerman LB, Frieden TR: Patient and health care system delays in the diagnosis and treatment of tuberculosis. Int J Tuberc Lung Dis. 1999, 3 (12): 1088-1095.
Aoki M, Shimao T: Studies on factors influencing patients', doctors' and total delay of tuberculosis case-detection in Japan. Int J Tuberc Lung Dis. 1985, 60 (3–4): 128-130.
Long NH, Johansson E, Lönnroth K, Eriksson B, Winkvist A, Diwan VK: Longer delays in tuberculosis diagnosis among women in Vietnam. Int Tuberc Lung Dis. 1999, 3: 388-393.
Auer C, Sarol J, Tanner M, Weiss M: Health seeking and perceived causes of tuberculosis among patients in manila. Trop Med Int Health. 2000, 5 (9): 648-656. 10.1046/j.1365-3156.2000.00615.x.
Godfrey-Faussett P, Kaunda H, Kamanga J, van Beers S, van Cleeff M, Kumwenda-Phiri R, et al: Why do patients with a cough delay seeking care at Lusaka urban health centers? A health systems research approach. Int J Tuberc Lung Dis. 2002, 6 (9): 796-805.