scholarly journals Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis

2021 ◽  
Vol 6 (4) ◽  
pp. 42
Author(s):  
Kenaw Tegegne Tefera ◽  
Fasil Wagnew ◽  
Yihalem Abebe Belay ◽  
Dawit Eyayu ◽  
Daniel Bekele Ketema
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Meta Analysis ◽  
System Delay ◽  
Tuberculosis Patients ◽  
Health System Delay

Health system delay in the treatment of tuberculosis patients in Ethiopia: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Kenaw Tegegne ◽  
Fasil Wagnew ◽  
Yihalem Abebe Belay ◽  
Dawit Eyayu ◽  
Daniel Bekele
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Median Time ◽  
Meta Analysis ◽  
A Priori ◽  
Rural Residence ◽  
System Delay ◽  
Tuberculosis Patients ◽  
Delay In Diagnosis ◽  
Health System Delay

Abstract Background: Delay in diagnosis and initiation of effective treatment associated with increase in morbidity, mortality and on-going person-to-person transmission in the community at large. In Ethiopia, several studies have been conducted regarding health system delay among tuberculosis patients. However, studies assessing the health system delay in treatment of tuberculosis patients in Ethiopia had inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. Methods: We systematically searched from different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus and Springer link databases for studies published from June 6, 1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. Heterogeneity was evaluated using I squared statistic. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using random-effects model in R version 4.0.3 software(for median estimation) and Stata version 14 (for metan). The pooled estimates with 95% confidence intervals (CI) were presented using forest plots. Results: A total of 14 studies which comprising 6161 patients satisfying a priori set criteria were included. Our meta-analysis showed that, the estimated pooled median time of the health system delay was 15.29(95%CI: 9.94–20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015 the pooled median health system delay was 21.63(95% CI: 14.38-28.88) days, whereas studies conducted after 2015 the pooled median time of 9.33(95% CI: 3.95-14.70) days. Living in rural area (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. Conclusions: In Ethiopia, patients are delayed more-than two weeks in the treatment of tuberculosis. Being from rural residence was more likely to lead prolonged health system delay. Implementing efforts by targeting rural residence may help to shorten the health system delay and important implications for the success of tuberculosis control.

scholarly journals The circuits of healthcare: Understanding healthcare seeking behaviour—A qualitative study with tuberculosis patients in Lisbon, Portugal

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261688
Author(s):  
Rafaela M. Ribeiro ◽  
Philip J. Havik ◽  
Isabel Craveiro
Keyword(s):  
Health System ◽  
Health Belief ◽  
System Delay ◽  
Structured Interviews ◽  
Tuberculosis Patients ◽  
Healthcare Seeking ◽  
Health System Delay ◽  
Services Delivery ◽  
Belief Model ◽  
Diagnostic Delays

Background Understanding health delivery service from a patient´s perspective, including factors influencing healthcare seeking behaviour, is crucial when treating diseases, particularly infectious ones, like tuberculosis. This study aims to trace and contextualise the trajectories patients pursued towards diagnosis and treatment, while discussing key factors associated with treatment delays. Tuberculosis patients’ pathways may serve as indicator of the difficulties the more vulnerable sections of society experience in obtaining adequate care. Methods We conducted 27 semi-structured interviews with tuberculosis patients attending a treatment centre in a suburban area of Lisbon. We invited nationals and migrant patients in active treatment to participate by sharing their illness experiences since the onset of symptoms until the present. The Health Belief Model was used as a reference framework to consolidate the qualitative findings. Results By inductive analysis of all interviews, we categorised participants’ healthcare seeking behaviour into 4 main types, related to the time participants took to actively search for healthcare (patient delay) and time the health system spent to diagnose and initiate treatment (health system delay). Each type of healthcare seeking behaviour identified (inhibited, timely, prolonged, and absent) expressed a mindset influencing the way participants sought healthcare. The emergency room was the main entry point where diagnostic care cascade was initiated. Primary Health Care was underused by participants. Conclusions The findings support that healthcare seeking behaviour is not homogeneous and influences diagnostic delays. If diagnostic delays are to be reduced, the identification of behavioural patterns should be considered when designing measures to improve health services’ delivery. Healthcare professionals should be sensitised and perform continuous capacity development training to deal with patients´ needs. Inhibited and prolonged healthcare seeking behaviour contributes significantly to diagnostic delays. These behaviours should be detected and reverted. Timely responses, from patients and the healthcare system, should be promoted.

scholarly journals Patient and health care system characteristics are associated with delayed treatment of tuberculosis cases in Taiwan

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chien-Chou Chen ◽  
Po-Huang Chiang ◽  
Yen-Hsu Chen ◽  
I-Chun Fan ◽  
Ta-Chien Chan
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Health System ◽  
Health Care System ◽  
Initial Visit ◽  
System Delay ◽  
Tuberculosis Patients ◽  
Health System Delay ◽  
Treatment Services ◽  
Care System

Abstract Background The decline of the incidence rate of tuberculosis in Taiwan has been partly attributed to the launch of the directly observed therapy short course (DOTS) program in 2006, followed by the DOTS-Plus in 2007. However, with the phasing out of the specialized tuberculosis care system and the declining incidence, clinical workers in Taiwan might become less familiar with the presentation of tuberculosis. Complementing the patient-pathway analysis with health system delay estimates, the objective of this study is twofold: to estimate the alignment between patient care initiation and the availability of prompt diagnostic and treatment services, and to identify the risk factors of delayed tuberculosis treatment. Methods The study population included all Taiwanese patients with incident tuberculosis in 2013. We (1) identified 11,507 incident tuberculosis patients from the 2013 National TB Registry, and (2) linked 10,932 Taiwanese from the registry to the 2012–2013 National Health Insurance Research Database. We assessed patient’s care-seeking pathways and associated the determinants of health system delay in a Cox model. Results The overall health system delay was 46 days. We found that 20.5 and 3.5% of 10,932 tuberculosis patients were diagnosed and treated respectively at the initial visit to seek care for TB-related symptoms. Risk factors related to the prolonged health system delay included female gender (adjusted HR = 0.921, 95% CI: 0.884, 0.960), age > =65 years (adjusted HR = 0.720, 95% CI: 0.692, 0.750), non-severe (chest X-ray without cavities) (adjusted HR =0.721, 95% CI 0.683–0.760), chronic respiratory diseases (adjusted HR = 0.544, 95% CI: 0.522, 0.566), living in long-term care facilities (adjusted HR = 0.580, 95% CI: 0.525,0.640), an initial visit at a primary care clinic (adjusted HR = 0.588, 95% CI: 0.565, 0.612), and living in southern Taiwan (adjusted HR = 0.887, 95% CI: 0.798, 0.987). Conclusions The low access to TB diagnostic and treatment services at the initial visit and the prolonged health system delay indicate inefficiency in the health care system. Strengthening training of physicians at public hospitals and health workers at nursing homes might improve the efficiency and timeliness of tuberculosis diagnosis and treatment in Taiwan.

scholarly journals Determinants of health system delay among confirmed tuberculosis cases in Spain

2005 ◽  
Vol 15 (4) ◽  
pp. 343-349 ◽  
Author(s):  
M. Díez ◽  
M.J. Bleda ◽  
J. Alcaide ◽  
C. Castells ◽  
J.I. Cardenal ◽  
...  
Keyword(s):  
Health System ◽  
Determinants Of Health ◽  
System Delay ◽  
Health System Delay

scholarly journals Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Benjamin Momo Kadia ◽  
Christian Akem Dimala ◽  
Noah T. Fongwen ◽  
Adrian D. Smith
Keyword(s):  
Systematic Review ◽  
Antiretroviral Therapy ◽  
Health System ◽  
Sample Size ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
System Level ◽  
Comprehensive Treatment ◽  
Barriers And Enablers ◽  
Sub Saharan

Abstract Introduction Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients’ access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA. Method A systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers. Results Of 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I2 = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level. Conclusions In SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes. Systematic review registration: CRD42019131933.

scholarly journals Active pulmonary tuberculosis and coronavirus disease 2019: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0259006
Author(s):  
Ashutosh Nath Aggarwal ◽  
Ritesh Agarwal ◽  
Sahajal Dhooria ◽  
Kuruswamy Thurai Prasad ◽  
Inderpaul Singh Sehgal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Tuberculosis ◽  
Patient Outcomes ◽  
Meta Analysis ◽  
Severe Disease ◽  
Random Effects Models ◽  
Tuberculosis Patients ◽  
Active Pulmonary Tuberculosis ◽  
Risk Of Mortality ◽  
Related Mortality

Objective The proportion of COVID-19 patients having active pulmonary tuberculosis, and its impact on COVID-19 related patient outcomes, is not clear. We conducted this systematic review to evaluate the proportion of patients with active pulmonary tuberculosis among COVID-19 patients, and to assess if comorbid pulmonary tuberculosis worsens clinical outcomes in these patients. Methods We queried the PubMed and Embase databases for studies providing data on (a) proportion of COVID-19 patients with active pulmonary tuberculosis or (b) severe disease, hospitalization, or mortality among COVID-19 patients with and without active pulmonary tuberculosis. We calculated the proportion of tuberculosis patients, and the relative risk (RR) for each reported outcome of interest. We used random-effects models to summarize our data. Results We retrieved 3,375 citations, and included 43 studies, in our review. The pooled estimate for proportion of active pulmonary tuberculosis was 1.07% (95% CI 0.81%-1.36%). COVID-19 patients with tuberculosis had a higher risk of mortality (summary RR 1.93, 95% CI 1.56–2.39, from 17 studies) and for severe COVID-19 disease (summary RR 1.46, 95% CI 1.05–2.02, from 20 studies), but not for hospitalization (summary RR 1.86, 95% CI 0.91–3.81, from four studies), as compared to COVID-19 patients without tuberculosis. Conclusion Active pulmonary tuberculosis is relatively common among COVID-19 patients and increases the risk of severe COVID-19 and COVID-19-related mortality.

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