Patient and health system delay among TB patients in Ethiopia : Nationwide mixed method cross-sectional study
(2020) In BMC Public Health 20(1).- Abstract
BACKGROUND: Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia.
METHODS: This is mixed method cross-sectional study conducted in seven regions and two... (More)
BACKGROUND: Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia.
METHODS: This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay.
RESULTS: Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10-45), 4 (2-10) and 2 (1-3) days respectively. The median (IQR) of total delay was 33 (19-67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. Poverty, cost of seeking care, protracted diagnostic and treatment initiation, inadequate community based TB care and lack of awareness were associated with delay. Community health workers reported that lack of awareness and the expectation that symptoms would resolve by themselves were the main reasons for delay.
CONCLUSION: TB patients' delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia.
(Less)
- author
- Datiko, Daniel G ; Jerene, Degu LU and Suarez, Pedro
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adolescent, Adult, Cluster Analysis, Cross-Sectional Studies, Delayed Diagnosis/statistics & numerical data, Ethiopia, Female, Health Facilities/statistics & numerical data, Health Services Accessibility/statistics & numerical data, Humans, Male, Middle Aged, Patient Acceptance of Health Care/statistics & numerical data, Social Stigma, Time Factors, Time-to-Treatment/statistics & numerical data, Tuberculosis, Pulmonary/diagnosis, Young Adult
- in
- BMC Public Health
- volume
- 20
- issue
- 1
- article number
- 1126
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85088216946
- pmid:32680489
- ISSN
- 1471-2458
- DOI
- 10.1186/s12889-020-08967-0
- language
- English
- LU publication?
- no
- id
- ae3e0f73-aa1a-4b9f-bfd7-c008d551609a
- date added to LUP
- 2021-09-08 17:47:53
- date last changed
- 2024-06-29 17:03:07
@article{ae3e0f73-aa1a-4b9f-bfd7-c008d551609a,
abstract = {{<p>BACKGROUND: Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia.</p><p>METHODS: This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay.</p><p>RESULTS: Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10-45), 4 (2-10) and 2 (1-3) days respectively. The median (IQR) of total delay was 33 (19-67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. Poverty, cost of seeking care, protracted diagnostic and treatment initiation, inadequate community based TB care and lack of awareness were associated with delay. Community health workers reported that lack of awareness and the expectation that symptoms would resolve by themselves were the main reasons for delay.</p><p>CONCLUSION: TB patients' delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia.</p>}},
author = {{Datiko, Daniel G and Jerene, Degu and Suarez, Pedro}},
issn = {{1471-2458}},
keywords = {{Adolescent; Adult; Cluster Analysis; Cross-Sectional Studies; Delayed Diagnosis/statistics & numerical data; Ethiopia; Female; Health Facilities/statistics & numerical data; Health Services Accessibility/statistics & numerical data; Humans; Male; Middle Aged; Patient Acceptance of Health Care/statistics & numerical data; Social Stigma; Time Factors; Time-to-Treatment/statistics & numerical data; Tuberculosis, Pulmonary/diagnosis; Young Adult}},
language = {{eng}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Public Health}},
title = {{Patient and health system delay among TB patients in Ethiopia : Nationwide mixed method cross-sectional study}},
url = {{http://dx.doi.org/10.1186/s12889-020-08967-0}},
doi = {{10.1186/s12889-020-08967-0}},
volume = {{20}},
year = {{2020}},
}