Delay in tuberculosis case-finding and treatment in Mwanza, Tanzania

Bugando Medical Centre, Mwanza, Tanzania.
The International Journal of Tuberculosis and Lung Disease (Impact Factor: 2.32). 03/2000; 4(2):133-8.
Source: PubMed


Health facilities in Mwanza region, Tanzania.
To determine factors responsible for delay from onset of symptoms of pulmonary tuberculosis to initiation of treatment.
A cross-sectional descriptive study of 296 smear-positive tuberculosis patients. Emphasis was given to periods between 1) onset of symptoms and first consultation to a health facility, and 2) reporting to a health facility and initiation of treatment.
Mean total delay was 185 days (median 136), with nearly 90% of this being patient's delay. The mean health system delay was 23 days (median 15), with longer delays in rural health facilities. The mean patient's delay was 162 days (median 120). This delay was significantly longer in rural areas, for patients with lower level of education, for those who first visited a traditional healer, and for patients who had no information on tuberculosis prior to diagnosis. Only 15% of the patients reported to a health facility within 30 days of onset of symptoms.
There are significant delays in case-finding in Mwanza, Tanzania, with prolonged patient's delay. Facilitation of utilisation of health services, raising awareness of the disease and incorporation of private practice into tuberculosis control could help to reduce these delays.

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    • "Patient delay in this study contributed least towards total delay. This is contrary to what was observed in a study from Tanzania where patient delay contributed to 90% of the total delay [23]. However the Tanzanian study used the following definition of patient delay “the period between onset of symptoms and reporting to a health facility.” "
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    ABSTRACT: Background Delay in tuberculosis (TB) diagnosis may worsen the disease and increase TB transmission. Therefore, timely diagnosis and treatment is critical in TB control. We aimed to assess the treatment delay of pulmonary TB and its determinants in two Ugandan districts where TB infection control (TBIC) guidelines were formerly implemented. Methods A facility based cross-sectional study was conducted in Mukono and Wakiso districts. Adult pulmonary TB patients within three months of initiating treatment were included in the study. Delays were categorized into unacceptable patient delay (more than 3 weeks from the onset of cough and the first consultation with a health care provider), health service (more than one week from the first consultation to the initiation of TB treatment) and total delay (more than 4 weeks since the onset of cough). The prevalences as well as predictors for the three delays were determined. Results We enrolled 158 sputum positive patients. Unacceptable patient delay was noted in 91 (58%) patients, a health service delay in 140 (88%) patients and a total delay in 140 (90%) patients. An independent predictor for patient delay was male gender (p < 0.001). First visiting a non-public health facility (p = 0.001) was an independent predictor of health service delay. Conclusion There is still a significant TB diagnosis and treatment delay in Uganda. Most of the delay was caused by health system delay in the non-public health care sector. There is need for TB advocacy in the community, training of health workers in TBIC and strengthening public-private partnerships in TB control.
    BMC Public Health 06/2014; 14(1):586. DOI:10.1186/1471-2458-14-586 · 2.26 Impact Factor
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    • "had MDR-TB, out of which 11 (68.8%) were new cases and 5 (31.2%) were previously treated patients [11]. If untreated, it has been shown that one smear-positive TB patient can infect up to 15 other people over the course of one year [12,13] highlighting the urgent need for rapid detection and adequate anti-TB treatment. Thus, the primary objective of this study was to genotypically characterize M. tuberculosis isolates collected from sputum smear-positive pulmonary TB patients in the city of Mwanza, using the well-established genotyping methods, spoligotyping and MIRU-VNTR. "
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    ABSTRACT: Background There is increasing evidence to suggest that different Mycobacterium tuberculosis lineages cause variations in the clinical presentation of tuberculosis (TB). Certain M. tuberculosis genotypes/lineages have been shown to be more likely to cause active TB in human populations from a distinct genetic ancestry. This study describes the genetic biodiversity of M. tuberculosis genotypes in Mwanza city, Tanzania and the clinical presentation of the disease caused by isolates of different lineages. Methods Two-hundred-fifty-two isolates from pulmonary TB patients in Mwanza, Tanzania were characterized by spoligotyping, and 45 isolates were further characterized by mycobacterium interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR). The patients’ level of the acute phase reactants AGP, CRP and neutrophil counts, in addition to BMI, were measured and compared to the M. tuberculosis lineage of the infectious agent for each patient. Results The most frequent genotype was ST59 (48 out of 248 [19.4%]), belonging to the Euro-American lineage LAM11_ZWE, followed by ST21 (CAS_KILI lineage [44 out of 248 [17.7%]). A low degree of diversity (15.7% [39 different ST’s out of 248 isolates]) of genotypes, in addition to a high level of mixed M. tuberculosis sub-populations among isolates with an unreported spoligotype pattern (10 out of 20 isolates [50.0%]) and isolates belonging to the ST53 lineage (13 out of 25 [52%]) was observed. Isolates of the ‘modern’ (TbD1-) Euro-American lineage induced higher levels of α1-acid glycoprotein (β = 0.4, P = 0.02; 95% CI [0.06-0.66]) and neutrophil counts (β = 0.9, P = 0.02; 95% CI [0.12-1.64]) and had lower BMI score (β = -1.0, P = 0.04; 95% CI[-1.89 – (-0.03)]). LAM11_ZWE (‘modern’) isolates induced higher levels of CRP (β = 24.4, P = 0.05; 95% CI[0.24-48.63]) and neutrophil counts (β = 0.9, P = 0.03; 95% CI[0.09-1.70]). Conclusion The low diversity of genotypes may be explained by an evolutionary advantage of the most common lineages over other lineages combined with optimal conditions for transmission, such as overcrowding and inadequate ventilation. The induction of higher levels of acute phase reactants in patients infected by ‘modern’ lineage isolates compared to ‘ancient’ lineages may suggest increased virulence among ‘modern’ lineage isolates.
    BMC Infectious Diseases 06/2014; 14(1):309. DOI:10.1186/1471-2334-14-309 · 2.61 Impact Factor
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    • "The overall median patient delay in this study was 30 days. This finding is lower than studies done in Ethiopia (60–63 days) [4] [22] [23] and other countries, Nepal (50 days) [24] and Tanzania (120 days) [12]. However, it is almost consistent with another study done in Ethiopia (28 days) [20]. "
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    ABSTRACT: Background: Unknown proportions of tuberculosis cases remain undiagnosed and untreated as result of several factors which further increases the number of tuberculosis cases per index case. Objective: To identify factors associated with patient's delay in initiating treatment of tuberculosis. Methods. Cross-sectional study was employed from January to April, 2013, in Bahir Dar Ethiopia. A total of 360 patients were included. Data were collected from tuberculosis patients using a semistructured questionnaire. Data were entered and analyzed using SPSS version 16 windows. Multivariate logistic regression analysis was used to identify factors associated with patient delay. Results: Of all patients, 211 (62%) sought medical care after the WHO recommended period (21 days). The median patient delays of smear positive, smear negative, and extrapulmonary patients were 27 (IQR: 10-59), 30 (IQR: 9-65), and 31 (IQR: 10-150) days, respectively, with statistically significant variations among them (ANOVA: F = 5.96; P < 0.003). Place of residence and educational status were the predictors of patient delay. Conclusion: Around two-thirds of all patients and more than half of smear positive tuberculosis patients were delayed in seeking medical care within the recommended period. Provision of DOTS service in the vicinity and health education on TB may reduce patient delay and its consequences.
    BioMed Research International 05/2014; 2014(rr-11):701429. DOI:10.1155/2014/701429 · 3.17 Impact Factor
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