Delay in tuberculosis case-finding and treatment in Mwanza, Tanzania
ABSTRACT 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.
- SourceAvailable from: Muluken Azage
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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)    and other countries, Nepal (50 days)  and Tanzania (120 days) . However, it is almost consistent with another study done in Ethiopia (28 days) . "
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; 2014:701429. DOI:10.1155/2014/701429 · 2.71 Impact Factor
Understanding Tuberculosis - Global Experiences and Innovative Approaches to the Diagnosis, 02/2012; , ISBN: 978-953-307-938-7
- "Delay in diagnosis may aggravate the disease, augment the risk of death and enhance person to person transmission in the community (Odusanya and Babafemi, 2004). In Tanzania, 15% of patients were found to report to a health facility within 30 days of the onset of symptoms (Wandwalo and Morkve, 2000) while studies from Nigeria reported 81% (Enwuru et al., 2002) and 83% (Odusanya and Babafemi, 2004) patients delay for more than one month. Reasons for this are patients visiting local and poorly equipped private medical facilities, chemists, prayer houses and traditional healers; coupled with these, are poor knowledge and awareness about the disease among Africans in general (Odusanya and Babafemi, 2004; Enwuru et al., 2007; Okeibunor et al., 2007). "
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- "volume 14 no 5 pp 564–570 may 2009 Ouedraogo et al. 2006). Most patients presented with symptoms suspicious for TB; thus, lack of diagnostic sensitivity of health workers is of concern (Wandwalo & Morkve 2000). Afghanistan has the highest TB burden in south Asia (World Health Organization 2007). "
ABSTRACT: To assess diagnosis and management of suspected pulmonary tuberculosis (TB) among patients with respiratory complaints attending Comprehensive Health Centers (CHCs) in Afghanistan. Consecutive consenting patients presenting with respiratory complaints at 24 health centres in eight provinces were enrolled between November 2005 and February 2006. Demographics, health histories, clinic provider and study representative exam findings and diagnoses, and diagnostic test results were recorded. Correlates of TB-suggestive symptoms (defined as cough >2 weeks and/or haemoptysis) were assessed by logistic regression. There were 1401 participants; 24.6% (n = 345) were children (age 17 or under). The TB-suggestive symptoms of cough >2 weeks and/or haemoptysis were reported by 407 (31.3%) and 44(3.3%), respectively, with 39 participants reporting both symptoms. Of 413 participants reporting TB-suggestive symptoms, only 178 (43%) were diagnosed as having suspected TB; 22.0% received no clinical diagnosis. Suspected TB was significantly associated with having a household member residing in a refugee camp within the last 2 years (OR = 6.0; 95% CI: 4.1-8.7), seven or more people sleeping in the same room (OR = 1.9; 95% CI: 1.4-2.6) and cooking with a wood fire in the sleeping room (OR = 1.6; 95% CI: 1.2-2.2) in univariate analysis. Diagnostic sensitivity by the health worker for possible cases of pulmonary TB was low, as 22% of persons with suspected tuberculosis received no diagnosis. Further, some common/chronic respiratory ailments were under-diagnosed. There is great need for improved practical training and continuing education in pulmonary disease diagnosis for clinical health workers.Tropical Medicine & International Health 03/2009; 14(5):564-70. DOI:10.1111/j.1365-3156.2009.02257.x · 2.30 Impact Factor