Time delay barriers in diagnosis and treatment of gastrointestinal cancer in Nepal.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19085-e19085
Author(s):  
Soniya Dulal ◽  
Bishnu D. Paudel ◽  
Prakash C. Neupane ◽  
Bibek Acharya ◽  
Sandhya Chapagain Acharya ◽  
...  
Keyword(s):  
Rural Areas ◽  
Safety Net ◽  
Cross Sectional Study ◽  
Medical Consultation ◽  
Diagnosis And Treatment ◽  
Diagnosis Delay ◽  
Self Medication ◽  
Cross Sectional ◽  
Delay In Diagnosis ◽  
Gi Cancers

e19085 Background: Gastrointestinal (GI) cancers represent a major health challenge worldwide including in Nepal where patients (pts) often present with advanced disease and outcomes are poor. The purpose of this study was to quantify and to determine the causes of delay in diagnosis and treatment of GI cancer pts in Nepal. Methods: An IRB-approved cross sectional study was performed in pts with GI cancers at safety net Bir Hospital, Kathmandu, Nepal. All diagnosed consenting pts, both in- and out-pts, were enrolled. Pts were interviewed with a standardized questionnaire from July 2018 to June 2019. The caregivers were allowed to answer on behalf of illiterate pts. Diagnosis delay was defined as days from first symptoms to pathological diagnosis. Patient delay was defined as days from first symptoms to first medical consultation. Treatment delay was defined as days from diagnosis to surgery and/or treatment by medical/radiation oncologist. Differences in median times to delay were compared with two-tailed t-tests (Prism 8.0) based on the identified potential causes of delays. Results: The median age at diagnosis was 53.5 (22-77) years and 62% were males; 46% were farmers, 29% were housewives, and the rest had various occupations. 73% were outpatient at diagnosis. 46% had gastroesophageal cancer (gastric – 38%; esophagus – 8%) and 54% had colorectal cancer (left sided colon - 23%, right sided colon -13%; rectum 18%). No patients with anal or small bowel cancer were identified. 84% presented with Stage III/ IV disease. 68% were illiterate, 89% had a history of self-medication prior to first medical consultation, 74% were from rural areas with limited healthcare facilities and 79% were unaware of causes of GI cancers. Only self-medication was associated with delays in diagnosis and patient delays (Table). Conclusions: Self-medication rather than seeking help from medical professionals led to significant delays in the diagnosis of GI cancers in Nepal. Reasons for these decisions will be explored in future studies and may be amenable to efforts such as lay navigation. [Table: see text]

Delay in diagnosis and treatment of gastrointestinal cancer in Nepal.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18269-e18269
Author(s):  
Soniya Dulal ◽  
Bishnu D. Paudel ◽  
Aarati Shah ◽  
Bibek Acharya ◽  
Sandhya Chapagain Acharya ◽  
...  
Keyword(s):  
Rural Areas ◽  
Diagnostic Delay ◽  
Treatment Delay ◽  
Medical Consultation ◽  
Diagnosis And Treatment ◽  
Histopathological Diagnosis ◽  
Diagnosis Delay ◽  
Self Medication ◽  
Delay In Diagnosis ◽  
Gi Cancers

e18269 Background: Gastrointestinal (GI) cancers represent a major health challenge worldwide including Nepal where patients (pts) often present with advanced disease. The purpose of this study was to determine the time delay in diagnosis and treatment by evaluating time from first symptoms to diagnosis and treatment and to identify contributing factors from both pts and the health system in Nepal. Methods: An IRB approved cross sectional study was performed in pts with GI cancers. 50 newly diagnosed pts were enrolled and interviewed with a standardized questionnaire during the last 6 months of 2018. Diagnosis delay was defined as time from first symptoms to histopathological diagnosis. Treatment delay was defined as time from diagnosis to surgery and/or treatment by medical/ radiation oncologist. Results: The median age at diagnosis was 52.5 years. 52% had gastroesophageal cancer and 48% had colorectal cancer. 84% presented with Stage III/ IV disease. The median diagnosis delay was 217 days and the median treatment delay was 37 days. The median patient delay (time from first symptoms to first medical consultation) was 150 days. 64% were illiterate, 94% had a history of self medication prior to first medical consultation, 68% were from rural areas with limited healthcare facilities and 72% were unaware of causes of GI cancers. Reasons for diagnostic delay appear to be self diagnosis, self medication and lack of a prompt referral system. Reasons for treatment delay included financial constraint, prolonged wait times for procedures and treatment due to limited skilled manpower. Conclusions: Our data shows there is a significant delay in diagnosis and treatment especially in the time from first symptoms to first medical consultation. We found many preventable reasons for this that, if addressed appropriately, could have a significant impact on reducing the morbidity and mortality of GI cancers. There is an urgent need for intensive and comprehensive cancer education in Nepal and other developing countries.

The Evaluation of the Awareness, Attitude and Practice of the Elderly Toward Self-Medication: A Cross-Sectional Study

Drug Research ◽  
2018 ◽  
Vol 68 (08) ◽  
pp. 475-480
Author(s):  
Mohammad Heidari ◽  
Mansureh Borujeni ◽  
Mansour Ghafourifard ◽  
Rahim Sheikhi
Keyword(s):  
Rural Areas ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Average Score ◽  
Self Medication ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Age Related ◽  
Significant Difference ◽  
Urban And Rural Areas

Abstract Introduction The prevalence of various diseases in the elderly has increased the use of drugs, which is coupled with age-related physiological changes and places the elderly at risk for multiple side effects. The present study aimed to determine awareness, attitudes and practices of elderly towards self-medication. Materials and Methods The sample included 300 participants over 60 years under any of the health centers in urban and rural areas of Abadeh city, who were selected based on stratified random sampling method. In order to collect data, the questionnaire including demographic information, awareness, attitude and performance of the elderly and the checklist of drug intractable consumption. Results Based on the results, 76% of the elderly reported drug consumption. Regarding lifestyle, the average score of the elderly’s awareness for the elderly who lived with and without families were 78.6±14.2 and 69.2±13.6, respectively. In other words, a significant difference was observed between these two groups. In addition, there was a significant between the elderly’s performance score with and without family members about the self-medication (p=0.001). Conclusion Considering the increase in self-medication among the elderly, adherence to prescription criteria for drug among this age group is recommended. Finally, designing and implementing various educational programs in health education center is necessary for the elderly and their families for the purpose of improving awareness and practice.

scholarly journals Clinical Features of Rheumatoid Arthritis in a Sub-Saharan African Population: A 308 Study Cases in Senegal

2014 ◽  
Vol 4 (1) ◽  
pp. 23-28
Author(s):  
Souhaibou Ndongo ◽  
Abdoulaye Pouye ◽  
Emeric Azankpan ◽  
Mourtalla M. Ka ◽  
Thérèse Moreira Diop
Keyword(s):  
Rheumatoid Arthritis ◽  
Rural Areas ◽  
Urban Areas ◽  
Cross Sectional Study ◽  
Sicca Syndrome ◽  
Sub Saharan Africa ◽  
Cross Sectional ◽  
Early Management ◽  
Delay In Diagnosis ◽  
Sub Saharan

Background: Rheumatoid arthritis, formerly rare in sub-Saharan Africa, is becoming increasingly reported. The objective study determines the epidemiological, clinical and biological features of rheumatoid arthritis at diagnosis. Methods: A cross-sectional study conducted at the rheumatology outpatient department of Aristide Le Dantec Teaching Hospital of Dakar in Senegal. Results: Three hundred eight patients with rheumatoid arthritis according, to American College of Rheumatology 1987 criteria, were included: 273 women and 35 men (ratio of 7:8). Median age was 41 years (Q1: 31; Q3: 53 years); predominant age group was 30-40 years. Ninety-three percent resided in urban areas and 7% in rural areas. Family history of chronic inflammatory arthritis was reported by 35.1% of patients. Thirty-nine percent of patients initially consulted a traditional healer. On admission, the median Disease Activity Score 28 was 6.5 (Q1: 5.5; Q3: 7.3). Rheumatoid arthritis was very active in 81.1% and a positive factor in 84% of patients. Cyclic citrullinated peptide antibodies assessed in 116 patients; 95 reported positive (81.9%). Of 169 patients, at least one extra-articular manifestation was presented; the most common, anemia and sicca syndrome. Conclusion: Rheumatoid arthritis was characterized by an important delay in diagnosis, a polyarticular presentation, and a high positivity of immunological markers. Extra-articular manifestations included mainly anemia and sicca syndrome. Early management and a better understanding of rheumatoid arthritis in sub-Saharan Africa are required.

scholarly journals FACTORS AFFECTING DELAY IN DIAGNOSIS OF COLORECTAL CANCER: A CROSS-SECTIONAL STUDY; FROM TERTIARY CARE HOSPITAL OF KARACHI PAKISTAN

2021 ◽  
Author(s):  
Rubab Nafees Ahmed ◽  
Lajpat Rai ◽  
Khursheed Ahmed Samo ◽  
Summaya Saeed ◽  
Ammara Salam ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Control Program ◽  
Cross Sectional Study ◽  
Diagnosis Delay ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Delay In Diagnosis ◽  
Presenting Symptoms ◽  
Keywords Colorectal Cancer

Background: CRC incidence is increasing in our region. There is no specific CRC control program or national cancer registry in Pakistan. Previously no data has been published on presentation and diagnosis delay of CRC in our region. This study is conducted to determine the factor affecting delay in presentation and diagnosis and to provide baseline information to launch a CRC control program. Primary objective is to determine factor causing delay in diagnosis of CRC. Secondary objective is to evaluate relationship between tumor site and stage of CRC with presenting symptoms and symptom duration. Methods: This project is a prospective cross-sectional study on 113 biopsy-proven CRC patients admitted to the surgical ward of civil hospital Karachi. Results: A total number of participants was 113. Presentation delay was observed in 83.2% of patients. The main reasons for a reported delay in the presentation were lack of patients’ knowledge that these symptoms may be cancer (60.4%), the wrong diagnosis by the primary physician (34.6%), or the patient didn’t want to visit the doctor (0.04%). Most tumors (95%) originated from the sigmoid and rectum. 38.9% and 44.2% of the patients diagnosed at Stage 4 and 3 respectively. Conclusions: This study revealed that CRC patients in Pakistan are facing delays in presentation and diagnosis. This is the reason behind diagnosis at the advanced stage with a poor prognosis. Based on this study findings CRC control program should be introduced to detect CRC at an early stage. Keywords: Colorectal cancer, Colon, Rectum, Cancer, Presentation delay, Diagnosis delay.

Endometriosis-Associated Symptoms and Diagnostic Delay: An Online Survey

2020 ◽  
Author(s):  
Maryam Moradi ◽  
Azin Niazi ◽  
Melissa Parker ◽  
Anne Sneddon ◽  
Violeta Lopez ◽  
...  
Keyword(s):  
Online Survey ◽  
Age Of Onset ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
Cross Sectional Study ◽  
Diagnosis Delay ◽  
Cross Sectional ◽  
Delay In Diagnosis ◽  
Associated Symptoms ◽  
Surgical Treatments

Abstract Background: Endometriosis is found in women of all ethnic and social groups with a prevalence of around 10%. However, data on diagnostic-delay and associated symptoms are limited. The aim of this study was to determine the endometriosis-associated symptoms and diagnosis-delay through an online survey. Methods: A cross-sectional study was conducted in Australia using an online web-based survey. All data were entered and analyzed using STATA (version 14/1). A total of 903 responders completed an online survey from September 2013 to October 2015.Results: Total participants of 903, 71.10% Australians (were born in Australia) and 28.90% Non-Australian (were not born in Australia), with self-reported diagnosis of endometriosis was confirmed by surgery in 86.5% of participants completed the online survey. Delay in diagnosis was 8.1±6.2 years. There was no difference between age range (p = 0.35), mean age of onset of the first symptoms (p = 0.93), and delay in diagnosis (p = 0.11) in both groups. Most common endometriosis-related symptoms that all responders had experienced in their lifetime were period pain 98.11%, fatigue 94.01%, bloating 90.69%, ovulation pain 88.70%, pelvic pain 87.26%, pain during before/after sexual activity 82.72% and heavy bleeding 82.17% and delayed fertility 37.98%. Treatments used in affected women included: pain killers 96.01% (n=867), hormonal medication 84.71% and surgical treatments 84.49 %. Rate of miscarriage or stillbirth was 13.4% and hysterectomy because of endometriosis was 9.6%. Conclusions: Vast similarities in demographics and endometriosis-associated symptoms among the Australian and non-Australian women with endometriosis support the universality of the disease characteristics. Delay in diagnosis of endometriosis is a problem and the reasons for delayed diagnosis must be better understood to try to shorten this delay. Except for pain, endometriosis patients suffer from a variety of symptoms and treatment must take into account the most prominent symptoms.

scholarly journals Knowledge, attitudes, and practices about dengue among pupils from rural schools in an endemic area in Colombia

Biomédica ◽  
2019 ◽  
Vol 39 (3) ◽  
pp. 478-490 ◽  
Author(s):  
Diana Sarmiento-Senior ◽  
María Inés Matiz ◽  
Juan Felipe Jaramillo-Gómez ◽  
Víctor Alberto Olano ◽  
Sandra Lucía Vargas ◽  
...  
Keyword(s):  
Rural Schools ◽  
Rural Areas ◽  
Endemic Area ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Self Medication ◽  
Mosquito Net ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Preventive Practices

Introduction: Dengue is a public health problem in tropical and subtropical regions of the world. Studies on dengue in rural areas are scarce since the disease is considered mainly urban.Objective: To determine the knowledge (K), attitudes (A) and practices (P) of dengue in an endemic area in Colombia.Materials and methods: We conducted a cross-sectional study with 515 pupils (7-16 years old) in 34 rural schools in Anapoima and La Mesa municipalities during 2011. Each KAP category was evaluated independently by a scoring system and then categorized into high, medium or low.Results: Pupils recognized knowledge variables such as the symptoms (fever, bone pain), transmission route (mosquito bites), and mosquito breeding sites (uncovered water tanks, solid waste). Average scores on attitude were high in both municipalities indicating a well-developed perception of disease severity. Seeking treatment in medical centers and self-medication for fever management and the use of mosquito net and space-spraying of insecticides were the most frequently identified practices.Discussion: This is the first KAP dengue study performed in a rural area in Colombia and as such it contributes to the understanding of dengue perceptions by the inhabitants of these areas. It showed a medium level of knowledge about dengue and a lower level of preventive practices in pupils from rural schools. It also showed that pupils considered space-spraying as crucial for vector control. The presence of the vector in rural areas of the country underlines the need to improve surveillance and education to more effectively control the vector and promote prevention methods including community participation.

scholarly journals Clinical Features of Rheumatoid Arthritis in a Sub-Saharan African Population: A 308 Study Cases in Senegal

2014 ◽  
Vol 4 (1) ◽  
pp. 23-28
Author(s):  
Souhaibou Ndongo ◽  
Abdoulaye Pouye ◽  
Emeric Azankpan ◽  
Mourtalla M. Ka ◽  
Thérèse Moreira Diop
Keyword(s):  
Rheumatoid Arthritis ◽  
Rural Areas ◽  
Urban Areas ◽  
Cross Sectional Study ◽  
Sicca Syndrome ◽  
Sub Saharan Africa ◽  
Cross Sectional ◽  
Early Management ◽  
Delay In Diagnosis ◽  
Sub Saharan

Background: Rheumatoid arthritis, formerly rare in sub-Saharan Africa, is becoming increasingly reported. The objective study determines the epidemiological, clinical and biological features of rheumatoid arthritis at diagnosis. Methods: A cross-sectional study conducted at the rheumatology outpatient department of Aristide Le Dantec Teaching Hospital of Dakar in Senegal. Results: Three hundred eight patients with rheumatoid arthritis according, to American College of Rheumatology 1987 criteria, were included: 273 women and 35 men (ratio of 7:8). Median age was 41 years (Q1: 31; Q3: 53 years); predominant age group was 30-40 years. Ninety-three percent resided in urban areas and 7% in rural areas. Family history of chronic inflammatory arthritis was reported by 35.1% of patients. Thirty-nine percent of patients initially consulted a traditional healer. On admission, the median Disease Activity Score 28 was 6.5 (Q1: 5.5; Q3: 7.3). Rheumatoid arthritis was very active in 81.1% and a positive factor in 84% of patients. Cyclic citrullinated peptide antibodies assessed in 116 patients; 95 reported positive (81.9%). Of 169 patients, at least one extra-articular manifestation was presented; the most common, anemia and sicca syndrome. Conclusion: Rheumatoid arthritis was characterized by an important delay in diagnosis, a polyarticular presentation, and a high positivity of immunological markers. Extra-articular manifestations included mainly anemia and sicca syndrome. Early management and a better understanding of rheumatoid arthritis in sub-Saharan Africa are required.

scholarly journals Prevalence of Self-medication and its Influence in the Labor Force in Rural Hlaing Tharyar, Yangon, Myanmar

2019 ◽  
Vol 12 (1) ◽  
pp. 38-44 ◽  
Author(s):  
Moe Thuzar ◽  
Pyae Linn Aung
Keyword(s):  
Social Support ◽  
Labor Force ◽  
Rural Areas ◽  
Multiple Logistic Regression Analysis ◽  
Cross Sectional Study ◽  
Self Medication ◽  
Cross Sectional ◽  
Change Communication ◽  
Rational Drug ◽  
Poor Social Support

Background: As self-medication is becoming the most familiar and preferred type of medical care in developing countries, this study was designed to measure the prevalence of self-medication and its influence on the labor force in rural areas of Hlaing Tharyar Township, Yangon, Myanmar. Methods: A cross-sectional study using structured questionnaires was conducted among 250 laborers during April 2015. Results: The prevalence of self-medication among the labor force was (89.2%) in which 64.0% had poor knowledge, 56.8% had poor perception, and 68.8% received poor social support for self-medication practices. A multiple logistic regression analysis revealed that three variables influenced self-medication practices: (1) decision-making role for the treatment of illness (odds ratio [OR] = 3.79, 95% confidence interval [CI] = 1.7–12.38); (2) poor perception (OR = 5.33, 95% CI = 1.66–17.08); and (3) poor social support (OR = 4.86, 95% CI = 1.61–14.63). Conclusion: These findings indicate the need for health education intervention and behavior change communication training for promoting rational drug use among this rural labor force.

scholarly journals Gender and time delays in diagnosis of pulmonary tuberculosis: a cross-sectional study from China

2019 ◽  
Vol 147 ◽  
Author(s):  
H. G. Chen ◽  
T. W. Wang ◽  
Q. X. Cheng
Keyword(s):  
Gender Differences ◽  
Pulmonary Tuberculosis ◽  
Rural Areas ◽  
Diagnostic Delay ◽  
Cross Sectional Study ◽  
Diagnosis Delay ◽  
Sectional Study ◽  
Short Delay ◽  
Cross Sectional ◽  
Increased Risk

AbstractGender inequality has severe consequences on public health in terms of delay in diagnosis of pulmonary tuberculosis (PTB). In order to explore gender-related differences in diagnosis delay, a cross-sectional study of 10 686 patients diagnosed with PTB in Yulin from 1 January 2009 to 31 December 2014 was conducted. Diagnosis delay was categorised into ‘short delay’ and ‘long delay’ by four commonly used cut-off points of 14, 30, 60 and 90 days. Logistic regression analysis was used to analyse gender differences in diagnostic delay. Stratified analyses by smear results, age, urban/rural were performed to examine whether the effect persisted across the strata. The median delay was 31 days (interquartile range 13–65). Diagnostic delay in females at cut-off points of 14, 30, 60 and 90 days had odds ratios (OR) of 0.99 (95% CI 0.91–1.09), 1.09 (95% CI 1.01–1.18), 1.15 (95% CI 1.05–1.26) and 1.18 (95% CI 1.06–1.31), respectively, compared with males. Stratified analysis showed that females were associated with increased risk of longer delay among those aged 30–60 years, smear positive and living in the rural areas (P < 0.05). The female-to-male OR increased along with increased delay time. Further inquiry into the underlying reasons for gender differences should be urgently addressed to improve the current situation.

scholarly journals The Misconception of Antibiotic Equal to an Anti-Inflammatory Drug Promoting Antibiotic Misuse among Chinese University Students

2019 ◽  
Vol 16 (3) ◽  
pp. 335 ◽  
Author(s):  
Weiyi Wang ◽  
Xiaomin Wang ◽  
Yanhong Jessika Hu ◽  
Dan Wu ◽  
Jingjing Lu ◽  
...  
Keyword(s):  
University Students ◽  
Rural Areas ◽  
Urban Areas ◽  
Cross Sectional Study ◽  
Self Medication ◽  
Chi Square ◽  
Cross Sectional ◽  
Inflammatory Drug ◽  
Chi Square Test ◽  
Anti Inflammatory

Massive misuse of antibiotics is one of the most important reasons for antimicrobial resistance (AMR). Misconceptions of antibiotics contribute to antibiotic misuse behaviors. This study aims to examine whether university students hold the misconception that Antibiotic is a Xiaoyanyao (literally means anti-inflammatory drug in Chinese), and association between this misconception and antibiotic misuse behaviors. A cross-sectional study was conducted among university students using the cluster random sampling method in six universities of six regions in China (one university per region). The Chi-square test was used to assess the relationship between the misconception and antibiotic misuse behaviors. Logistic regression was conducted to identify the risk factors for antibiotic misuse behaviors. 11,192 of university students completed the entire questionnaire. There were 3882 (34.7%) students who were considered to have the misconception. Female students were more likely to have the misconception compared with males (36.7% vs. 32.6%, P < 0.001). Those students with a background of social science/humanities were more likely to have the misconception compared with those from science and medicine (44.1% vs. 30.3% vs. 20.1%, P < 0.001). Students came from rural areas compared with those from urban areas (37.5% vs. 32.5%, P < 0.001) were more likely to have the misconception. Students who had the misconception were 1.51 (95% CI 1.21–1.89, P < 0.001) times, 1.34 (95% CI 1.21–1.48, P < 0.001) times, and 1.36 (95% CI 1.24–1.50, P < 0.001) times more likely to report self-medication, request to obtain antibiotics, and take antibiotics prophylactically than those who did not have this misconception, respectively. The high proportion of university students' misconception on Antibiotic is a Xiaoyanyao is worth more attention. Effective health education and interventions need to be promoted among university students and the whole population.

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