Tuberculosis’ Total Health care system and patient side diagnosis and Treatment Delay and Associated Factors Among Pulmonary Tuberculosis Patients At Hadiya Zone Public Health Facilities, Southern Ethiopia.

Background: Delay in TB treatment is significant to both disease prognoses at the individual level and within the community. Even though studies conducted in TB treatment delay there is result inconsistencies due to differences in culture, environment and infrastructure. Objective: the aim of the study is to assess the tuberculosis treatment Delay and associated factor among pulmonary tuberculosis patients. Method: Facility based cross sectional study triangulated by Qualitative study was employed on 340 PTB patients in Hadiya zone public health facilities. Three woredas and health facilities were selected by Simple random sampling method. DOTS user at the beginning of data collection was consecutively recruited in to the study until the intended sample size was fulfilled. Multivariable binary Logistic regression was used. A P-value < 0.05 at 95 % CI was considered statistical significance between dependent and predictors variables. Result: Among 340 PTB patients enrolled in the study, of which 49.1% experienced patient delay, 30% health system delay and 49.8% total delay. Unable to read and write, Poor knowledge of TB (AOR 3.96, 95% CI (2.28 6.86), self-treatment (AOR: 2, 95% CI (1.14, 3.93), financial constraint (AOR: 2.092, 95% CI (1.11, 3.945) , Visiting two or more health care providers (AOR: 3.40, 95% CI (1.910 – 6.07), prolonged referral (AOR: 3.004, 95% CI (1.59, 5.67) were independent predictors of delay. Conclusion: Nearly half of the total delay was contributed by patient delay. Unable to read and write, Poor knowledge of TB, self-treatment, financial constraints, prolonged referral, several visit of health care provider of two or more and ever used other drugs rather than Anti-TB drugs were found to have association with patient delay and health system delay. Keywords: Tuberculosis treatment delay, PTB, patient delay and health system delay, Hadiya zone, Ethiopia.

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Patient and health system delays among tuberculosis patients attending DOTS centres of Kamrup (metro) district, Assam

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20172157 ◽

2017 ◽

Vol 4 (6) ◽

pp. 1961

Author(s):

Abhishek Gope ◽

Kanika K. Baruah ◽

Jutika Ojah ◽

Rupali Baruah

Keyword(s):

Health Care ◽

Health System ◽

Health Care Providers ◽

Patient Delay ◽

Effective Control ◽

Care Providers ◽

System Delay ◽

Health System Delay ◽

The Mean ◽

Formal Health Care

Background: Among the North eastern states, Assam has the highest burden of tuberculosis. Early diagnosis and prompt treatment is essential for effective control of tuberculosis.Methods: A cross sectional study was conducted among new smear positive tuberculosis cases above 15 years in Kamrup (Metrolpolitan) district of Assam from August 2015 to July 2016.Results: The mean patient delay was 34.2 days and the mean health system delay was 30.34 days. Female gender and patients who made first contact with non-formal health care providers were significantly associated with patient delay while illiteracy and age more than 35 years had significant association with health system delay.Conclusions: Median patient delay was found to be more than median health system delay. As patient delay was significantly associated with non-formal health care providers, the study proposes integration of non-formal health care providers with RNTCP which can reduce the patient delay.

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Facteurs De Retard Diagnostique De La Tuberculose Pulmonaire Vus À l’Unité De Soins, De Formation Et De Recherche De Pneumologie Befelatanana

European Scientific Journal ESJ ◽

10.19044/esj.2017.v13n27p413 ◽

2017 ◽

Vol 13 (27) ◽

pp. 413

Author(s):

Ravahatra Kiady ◽

Michel Tiaray Harison ◽

Rakotondrabe Iantsotiana Davidson ◽

Rasoafaranirina Marie Odette ◽

Nandimbiniaina Anjara ◽

...

Keyword(s):

Health System ◽

Patient Delay ◽

Diagnosis Delay ◽

System Delay ◽

Total Delay ◽

Delay In Diagnosis ◽

Health System Delay ◽

Tuberculosis Diagnosis ◽

Tuberculose Pulmonaire ◽

A Prospective Study

Delay in diagnosis is significant to tuberculosis prognosis. The aim of this study is to evaluate the diagnosis delay of tuberculosis and to identify determinants of “patient delay”, “health system delay”, and “total delay” in the diagnosis of tuberculosis. It is a prospective study of the patients who were hospitalized at the Unité de Soins de Formation et de Recherche (USFR) of Pneumology in Befelatanana, Antananarivo Madagascar, during the period of 1 st October 2014 to 30 April 2015 (7 months). We included all patients with diagnosis of pulmonary tuberculosis. Sixty six patients were also included. The mean time of patient delay, health system delay, and total delay were 26,30± 36,87, 69,56±64, and 96,35±72,65 days respectively. The different variables that affected diagnosis delay were: tobacco smoke (OR : 3,6723), asthenia (OR : 5,4815), anorexia (OR : 2,9524), and hemoptysis (OR : 0,2406) for the total delay. Knowledge about tuberculosis signs (OR : 0,164) and transmissions (OR : 0,243) was for the patient delay. Hemoptysis (OR : 8,1250), asthenia (OR : 0,1081), breathlessness (OR : 0,3556), infiltrative syndrome (OR : 0,2500), and alveolar syndrome (OR : 0,0687) in chest Xray was for the health system delay. Having an understanding of these factors of tuberculosis diagnosis delay will result to a decrease in the diagnosis delay.

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Diagnostic Pathways and Delays in Initiation of Treatment among Newly Diagnosed Tuberculosis Patients in Ballabgarh, India

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-1297 ◽

2021 ◽

Vol 104 (4) ◽

pp. 1321-1325

Author(s):

Ankit Chandra ◽

Rakesh Kumar ◽

Shashi Kant ◽

Anand Krishnan

Keyword(s):

Health System ◽

Health Facility ◽

Patient Delay ◽

Newly Diagnosed ◽

System Delay ◽

Total Delay ◽

Delay In Diagnosis ◽

Health System Delay ◽

Private Health Facility ◽

Diagnostic Pathways

ABSTRACTA delay in diagnosis and initiation of treatment in patients with tuberculosis (TB) can affect the period of communicability and cost of treatment. We aimed to describe the diagnostic pathways and delays in initiation of treatment among drug-sensitive newly diagnosed TB patients in Ballabgarh, India. In May 2019, we interviewed 110 TB patients who were put on treatment in the past 2 months. It was a cross-sectional study where data collection was conducted by a physician. We used a structured questionnaire to collect the information on care-seeking practices, delays, and patient’s cost. Descriptive analysis was carried out for the pathways, delays, and patient cost. The mean number of health facility contacted before the diagnosis of TB was 2.8 (SD: 1.3); 76% of patients first sought care at a private health facility. The median total delay was 34.5 (IQR: 21–60) days; median patient delay seven (IQR: 2–21) days, median health system delay 16 (IQR: 8–45) days, median diagnostic delay 32.5 (IQR: 18–57) days, and median treatment delay two (IQR: 1–3) days. Health system delay was 2.2 times longer than patient delay; the health system delay was primarily due to delay in diagnosis. Patients contacting private health facility first had 1.7 times total delay, 2.4 times longer health system delay, and 3.4 times of direct cost compared with patients contacting a public health facility first. Accelerated efforts are needed to achieve India’s target to eliminate TB by 2025.

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Delay in diagnosis and treatment among registered TB patients in Directly Observed Treatment Short Course cum Designated Microscopy Centres in South Delhi

Indian Journal of Community Health ◽

10.47203/ijch.2021.v33i02.021 ◽

2021 ◽

Vol 33 (2) ◽

pp. 344-350

Author(s):

Arunraj Kamaraj ◽

Manish Kumar Goel ◽

Jyoti Khandekar ◽

Khalid Umer Khayyam ◽

Sanjeev Kumar Rasania

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Providers ◽

Diagnostic Delay ◽

Treatment Delay ◽

Treatment Seeking ◽

Care Providers ◽

System Delay ◽

Total Delay ◽

Care System

Background: Knowing delays in treatment seeking and subsequent treatment initiation among the TB patients is important and its detailed understanding is crucial in modifying the treatment seeking behaviour which can help in reducing the TB burden and the transmission in the community. Aim & Objective: To study the treatment seeking behaviour including the delays in initiation of treatment along with its determinants; among tuberculosis patients aged > 15 years in Mehrauli area of Delhi. Settings and Design: A longitudinal follow up study conducted in two randomly selected DMC cum DOTS centres in Mehrauli area of Delhi from January 2018 to April 2018. Methods and Material: Patients of both sexes of age > 15 years, registered under RNTCP from January to April 2018 in the randomly selected DOTS centres i.e. Mehrauli DMC cum DOTS and Chattarpur DMC cum DOTS centre were included in the study. Self-designed, pretested interview schedule and records of DMC were used to collect the relevant information. Statistical analysis used: Information collected in the Performa was coded and entered in Statistical Package for Social Sciences (SPSS) version 12. Results: The mean patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 48.91 ± 130.38 days, 91.09 ± 155.97 days, 6.25 ± 6.29 days, 62.72 ± 119.48 days and 97.33 ± 155.06 days respectively. The median patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 15 days, 45 days, 5 days, 35 days and 54 days respectively. Conclusions: The major reasons for patient’s delay were lack of awareness regarding the symptoms of TB and self-medication and for health care system delay it was treatment from private health care providers.

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Factors Associated with Treatment Delay among Pulmonary Tuberculosis Patients in Public and Private Health Facilities in Addis Ababa, Ethiopia

Tuberculosis Research and Treatment ◽

10.1155/2017/5120841 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Getinet Shewaseged Adenager ◽

Fessahaye Alemseged ◽

Henok Asefa ◽

Amanuel Tesfay Gebremedhin

Keyword(s):

Health Care ◽

Health Care System ◽

Addis Ababa ◽

Treatment Delay ◽

System Delay ◽

Pulmonary Tb ◽

Experienced Patient ◽

Tb Treatment ◽

Total Treatment ◽

Care System

Background. Early detection and diagnosis of tuberculosis (TB) and the timely commencement of antituberculosis (anti-TB) treatment are the parts of efficient tuberculosis prevention and control program. Delay in the commencement of anti-TB treatment worsens the prognosis and increases the risk of death and the chance of transmission in the community and among health care workers. Objective. To assess tuberculosis treatment delay and associated factors among pulmonary TB patients in Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted in 10 public and 10 private health facilities that provide TB treatment. The data were collected from 425 newly registered pulmonary TB patients using pretested structured questionnaire from April to June 2012. Data were entered in EPI info version 3.5.1 and analyzed using SPSS version 16.0. Findings. The median durations of a patient, health care system, and total treatment delays were 17, 9, and 35 days, respectively. Overall 179 (42.1%), 233 (54.8%), and 262 (61.6%) of patients experienced patient delay, health care system delay, and total treatment delay, respectively. Distance more than 2.5 km from TB treatment health facility [AOR = 1.6, 95% CI (1.1–2.5)] and the presence of TB-associated stigma [AOR = 2.1, 95% CI (1.3, 3.4)] indicate higher odds of patient delay, whereas, being unemployed, patients with the hemoptysis symptom complain indicated lower odds of health care system delay [AOR = 0.41, 95% CI (0.24, 0.70)] and [AOR = 0.61 (0.39, 0.94)], respectively. Conclusions. A significant proportion of clients experienced patient and health care system delay. Thus, there is a need for designing and implementing appropriate strategies to decrease the delays. Efforts to reduce delays should give focus on integrating prevention programs such as active case detection and expanding access to TB care.

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

BMC Health Services Research ◽

10.1186/s12913-019-4702-0 ◽

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.

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Comparison of Delay in Tuberculosis Diagnosis Between Migrants and Local Residents in an Eastern County of China: An Analysis of the Electronic Data Between 2015 and 2019

Frontiers in Public Health ◽

10.3389/fpubh.2021.758335 ◽

2021 ◽

Vol 9 ◽

Author(s):

Wenhui Xiao ◽

Bin Chen ◽

Dajiang Huang ◽

Olivia Chan ◽

Xiaolin Wei ◽

...

Keyword(s):

Health System ◽

Diagnostic Delay ◽

Information Management System ◽

Evidence Base ◽

Patient Delay ◽

Rank Test ◽

Time Interval ◽

System Delay ◽

Early Screening ◽

Health System Delay

Introduction: China continues to rank among one of the countries with the highest number of tuberculosis (TB) cases globally. Migrants are a particularly at-risk subgroup for TB and pose a challenge for case management in contemporary China. The early diagnosis and treatment of patients with TB are pivotal for effective TB control. This study investigates the delay in the TB diagnosis of migrants as compared with residents, to provide an evidence base for improved case detection and the better management of migrant patients with TB.Materials and Methods: The data was collected from the Tuberculosis Information Management System (TBIMS) (2015–2019) in an eastern county of China. The total diagnostic delay, consisting of patient delay and health system delay, is defined as the interval between the onset of TB symptoms and the confirmation of TB diagnosis in the designated TB hospital. The comparison of the delay in the TB diagnosis between migrants and residents was conducted using a Mann-Whitney U-test and chi-square test. The difference in the delay curves between these two groups was examined using a log-rank test.Results: Of 2,487 patients with TB, 539 (22%) were migrants. The migrants tended to be younger, presented with less severe conditions, received an initial diagnosis at prefectural and above-level hospitals. Compared with the local patients with TB, the migrant patients with TB had a longer median total diagnostic delay (30 vs. 9, P = 0.000) and a higher proportion of patients with this delay >28 days (52 vs. 13%, P = 0.000). Similarly, the migrant patients with TB also had a longer median patient delay (13 vs. 9, P = 0.000) and a higher proportion of patients with this delay >14 days (47 vs. 30%, P = 0.000), longer median health system delay (9 vs. 0, P = 0.000), and a higher proportion of patients with this delay >14 days (42 vs. 0.5%, P = 0.000) than the local patients with TB. The survival curves of delay showed that the longer the time interval was, the more likely the migrant patients with TB were to be diagnosed (P < 0.05).Conclusions: Diagnosis is significantly delayed among migrant patients with TB. Our study highlights the importance of early screening and diagnosis for TB especially among migrants, to improve access and ensure better management for all patients with TB.

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Diagnostic and treatment challenges of adolescent and young adult oncology patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9557 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9557-9557

Author(s):

Yanqing Xu ◽

Mauro Cardoso ◽

Michael Ostaric Palumbo ◽

Olivia Ishibashi ◽

Petr Kavan

Keyword(s):

Health Care ◽

Health Care System ◽

Symptom Onset ◽

Delay Time ◽

Treatment Delay ◽

Patient Delay ◽

Adolescent And Young Adult ◽

Diagnosis And Treatment ◽

System Delay ◽

Care System

9557 Background: Adolescent and young adult (AYA) cancer patients are faced with obstacles and challenges related to their diagnosis and treatment compared to children and older adults. The aim of this study was to explore the patient and health care system-related delays in the interval from cancer symptom onset to diagnosis and treatment as well as to identify the possible contributing factors to these delays in the AYA group. Methods: This study was based on a questionnaire conducted in 2010-2011 completed by patients diagnosed with a malignancy between the ages of 16 and 39 in addition to older patients diagnosed with a pediatric type malignancy. Four categories of delays: patient delay (time from patient symptom onset until first health care contact date), health care system delay (time from first health care contact until diagnosis date), treatment delay (time from diagnosis date until first treatment) and oncologist delay (time from first health care contact until first medical oncologist meeting) were calculated. Median delay (in days) with interquartile interval (IQI) was the main outcome measure. Median time for each category of delay was further analysed to explore how they vary with different patient characteristics. Results: We identified a median patient delay of 30 days (IQI 1-131), a median health care system delay of 53 days (IQI 1-213), a median treatment delay of 36 days (IQI 5-92) and a median oncologist delay of 77 days (IQI 30-281). Patient delay was affected by patient gender, age at diagnosis and type of first health care contact. Health care system delay was associated with patient marital status, financial situation and attitude of first health care professional. Treatment delay was related to type of cancer. Conclusions: The health care system delay (including oncologist delay) accounts for much of the delay from symptom onset to first treatment. Professional characteristics of frontline medical personnel as well as socioeconomic and biological characteristics of the patients may contribute to delay. Healthcare professionals and the general community as a whole need to be aware of the factors contributing to delay in diagnosis and treatment in the underserved patient population.

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