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: 2.76). 03/2000; 4(2):133-8.
Source: PubMed

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.

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    ABSTRACT: Background 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. 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].Conclusion Patient delays were longer and more prevalent, suggesting the need for strategies aimed at promoting timely seeking of appropriate medical consultation among presumptive TB patient. 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.
    BMC Public Health 01/2015; 15(1):29. DOI:10.1186/s12889-015-1437-7 · 2.32 Impact Factor
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    ABSTRACT: Objectives. To measure delays from onset of symptoms to initiation of treatment in patients with smear-negative and smear-positive pulmonary tuberculosis and to identify reasons for these delays. Methods. A total of 136 newly diagnosed pulmonary tuberculosis patients were interviewed using a structured questionnaire. Results. The patients were divided into two groups. Group 1 included 65 smear-negative patients. There were 71 smear-positive patients in group 2. The median application interval was 10 days in group 1 and 14 days in group 2. While 24.6% of the patients had patient delay in group 1, patient delay was present in 33.8% of the patients in group 2 (P > 0.05). The median health care system interval was 41 days in group 1 and 16 days in group 2 (P < 0.0001). The most common reason for patient delay was neglect of symptoms by patient in both groups. A low index of suspicion for tuberculosis by physicians was the most common reason for doctor delays. Conclusions. Delays are common problem in smear-negative and smear-positive pulmonary tuberculosis patients. Delays should be reduced to reach an effective tuberculosis control. Education of public and physicians about tuberculosis is the most important effort to reduce delays.
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