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Wang X, Li Y, Fu Q, Zhou M. Trends of a decade in risk factors of patient delay among pulmonary tuberculosis patients during fast aging and urbanization - analysis of surveillance data from 2008 to 2017 in Wuhan, China. BMC Public Health 2023; 23:803. [PMID: 37131129 PMCID: PMC10155439 DOI: 10.1186/s12889-023-15707-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a leading infectious cause of morbidity and mortality worldwide. However, delay in health care seeking has remained unacceptably high. The aim of this study was to clarify the trend of patient delay and its associated risk factors during rapid aging and urbanization in Wuhan, China from 2008 to 2017. METHODS A total of 63,720 TB patients registered at Wuhan TB Information Management System from January 2008 to December 2017 were included. Long patient delay (LPD) was defined as patient delay longer than 14 days. Independent associations of area and household identity with LPD, as well their interaction effect, were tested by logistic regression models. RESULTS Among 63,720 pulmonary TB patients, 71.3% were males, the mean age was 45.5 ± 18.8 years. The median patient delay was 10 days (IQR, 3-28). A total of 26,360 (41.3%) patients delayed for more than 14 days. The proportion of LPD decreased from 44.8% in 2008 to 38.3% in 2017. Similar trends were observed in all the subgroups by gender, age and household, except for living area. The proportion of LPD decreased from 46.3 to 32.8% in patients living near downtown and increased from 43.2 to 45.2% in patients living far from downtown. Further interaction effect analysis showed that among patients living far from downtown, the risk of LPD for local patients increased with age, while decreased with age for migrant patients. CONCLUSION Although the overall LPD among pulmonary TB patients declined in the past decade, the extent of reduction varied in different subgroups. The elderly local and young migrant patients living far from downtown are the most vulnerable groups to LPD in Wuhan, China.
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Affiliation(s)
- Xiaojun Wang
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
| | - Yuehua Li
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China.
| | - Meilan Zhou
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
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Danarastri S, Perry KE, Hastomo YE, Priyonugroho K. Gender differences in health-seeking behaviour, diagnosis and treatment for TB. Int J Tuberc Lung Dis 2022; 26:568-570. [PMID: 35650695 PMCID: PMC9165739 DOI: 10.5588/ijtld.21.0735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - K E Perry
- FHI 360 Asia Pacific Regional Office, Bangkok, Thailand
| | - Y E Hastomo
- FHI 360 Indonesia Office, Jakarta, Indonesia
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Gender Differences in Factors Associated with the Total Delay in Treatment of Pulmonary Tuberculosis Patients: A Cross-Sectional Study in Selangor, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106258. [PMID: 35627796 PMCID: PMC9140698 DOI: 10.3390/ijerph19106258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022]
Abstract
Background: Gender plays a significant role in health-care-seeking behavior for many diseases. Delays in seeking treatment, diagnosis, and treatment for pulmonary tuberculosis (pTB) may increase the risk of transmission in the community and lead to poorer treatment outcomes and mortality. This study explores the differences in factors associated with the total delay in treatment of male and female pTB patients in Selangor, Malaysia. Methods: A cross-sectional study was conducted from January 2017 to December 2017. Newly diagnosed pTB patients (≥18 years) were recruited from selected government health clinics and hospitals in Selangor during the specified study period. An interviewer-administered questionnaire was used to collect information on sociodemographic characteristics, lifestyle, knowledge about pTB, stigma, distance to the nearest health facility, and chronology of pTB symptom onset, diagnosis, and treatment. The total delay was measured as the length of time between the onset of pTB symptoms to treatment initiation. Factors significantly associated with a longer total delay among men and women were identified using binary logistic regression. Results: A total of 732 patients (61.5% men, 38.5% women) were enrolled in the study. The median total delay was 60 days. Men who have weight loss as a symptom (AOR: 1.63, 95%CI: 1.10–2.41) and are employed (1.89, 1.15–3.11) were more likely to have a longer total delay, while those who know others who have had pTB (0.64, 0.43–0.96) were less likely to have a longer total delay. On the other hand, among women, having a stigma towards TB (0.52, 0.32–0.84) and obtaining a pTB diagnosis at the first medical consultation (0.48, 0.29–0.79) were associated with a shorter total delay. Conclusion: Factors associated with the total delay in pTB treatment were different for male and female pTB patients. Increasing awareness of pTB symptoms and the importance of seeking early medical consultation and a prompt diagnosis among the general public may reduce total delay in pTB treatment.
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Silva TCD, Pinto ML, Orlandi GM, Figueiredo TMRMD, França FODS, Bertolozzi MR. A tuberculose na perspectiva do homem e da mulher. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0137pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
RESUMO Objetivo: Analisar aspectos relacionados à vivência da tuberculose na perspectiva de homens e mulheres portadores de tuberculose. Método: Estudo transversal qualiquantitativo. Entrevistou-se, por meio de questionário semiestruturado, pacientes com tuberculose no município de Campina Grande-PB, entre setembro/2017 e janeiro/2018. Realizou-se Análise de Discurso e teste Qui-Quadrado. Resultados: Entrevistaram-se 63 sujeitos, sendo 34 (54,0%) do sexo masculino. Evidenciou-se associação da categoria gênero com escolaridade (p = 0,004), atividade de trabalho (p = 0,023), tempo despendido em atividades fora do domicílio (p = 0,013) e tempo despendido em atividades no domicílio (p = 0,001). A análise dos depoimentos revelou, principalmente, que o homem percebe seu papel como provedor principal da família e, a mulher, no papel social de cuidadora, adiando muitas vezes a busca por um serviço de saúde com receio de não conseguir exercer esse papel na família e/ou na sociedade. Conclusão A debilidade causada pela doença e a longa duração do tratamento mudaram a rotina dos entrevistados, causando sofrimento e frustração, com decorrências no desempenho dos papéis sociais no interior da família e na sociedade, constituindo-se em barreira na adesão ao tratamento da tuberculose.
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Silva TCD, Pinto ML, Orlandi GM, Figueiredo TMRMD, França FODS, Bertolozzi MR. Tuberculosis from the perspective of men and women. Rev Esc Enferm USP 2022; 56:e20220137. [PMID: 36346187 PMCID: PMC10081684 DOI: 10.1590/1980-220x-reeusp-2022-0137en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Abstract
ABSTRACT Objective: To analyze aspects related to the experience of tuberculosis from the perspective of men and women with tuberculosis. Method: Qualiquantitative cross-sectional study. Patients with tuberculosis in the city of Campina Grande-PB were interviewed through a semi-structured questionnaire between September/2017 and January/2018. Discourse Analysis and Chi-Square test were performed. Results: Sixty-three subjects were interviewed, of which 34 (54.0%) were men. There was an association of the category gender with level of education (p = 0.004), work activity (p = 0.023), time spent on activities outside the home (p = 0.013), and time spent on activities at home (p = 0.001). The analysis of the statements specially revealed that men perceive their role as the family’s main provider and the women with a social role of caregiver, often postponing the search for a health care due to fear of not being able to perform this role in the family and/or in society. Conclusion: The weakness caused by the disease and the long duration of treatment changed the interviewees’ routine, causing suffering and frustration, with consequences in the performance of social roles within the family and in society, constituting a barrier to adherence to tuberculosis treatment.
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Bohlbro AS, Mendes AM, Sifna A, Patsche CB, Gomes V, Wejse C, Rudolf F. Assessing gender differences among presumed and diagnosed patients with pulmonary TB: observations from Guinea-Bissau. Trans R Soc Trop Med Hyg 2021; 115:1273-1281. [PMID: 34542154 DOI: 10.1093/trstmh/trab145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/15/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Globally, more males than females are diagnosed with pulmonary TB (PTB); however, the cause of this gender disparity remains unknown. We aimed to assess gender differences in an observational cohort of patients with presumed PTB (prePTB) at the Bandim Health Project, Guinea-Bissau. METHODS Adult patients with signs and symptoms suggestive of PTB seeking medical care were invited to participate and were referred to comprehensive diagnostic work-up. RESULTS We included 2020 patients with prePTB; 54.6% were female. Females were younger than males and more often infected with HIV. More male patients with prePTB were diagnosed with PTB and the proportion of smear-positive cases was greater among males. There was no gender difference in loss to follow-up during the diagnostic process. Of 219 patients with PTB, 205 started treatment, with no difference between genders regarding pretreatment loss to follow-up or treatment outcome. CONCLUSIONS More women sought help for symptoms indicative of PTB, yet more men were diagnosed. Women did not have more clinically severe disease at presentation, did not drop out of diagnostic procedures more frequently and did not experience a worse outcome than men. This suggests that the gender gap in PTB is unlikely to be due solely to differences in care-seeking behaviour or diagnostic procedures in our setting.
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Affiliation(s)
- Anders Solitander Bohlbro
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | | | - Armando Sifna
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
| | - Cecilie Blenstrup Patsche
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.,GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Victor Gomes
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
| | - Christian Wejse
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Frauke Rudolf
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Zhai J, Peng R, Wang Y, Lu Y, Yi H, Liu J, Lu J, Chen Z. Factors Associated With Diagnostic Delays in Human Brucellosis in Tongliao City, Inner Mongolia Autonomous Region, China. Front Public Health 2021; 9:648054. [PMID: 34692615 PMCID: PMC8526552 DOI: 10.3389/fpubh.2021.648054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/30/2021] [Indexed: 01/19/2023] Open
Abstract
The diagnostic delays pose a huge challenge to human brucellosis (HB), which increases the risk of chronicity and complications with a heavy disease burden. This study aimed to quantify and identify the associated factors in the diagnostic delays to its prevention, reduction, and elimination. This study analyzed risk factors associated with the diagnostic delays in a cross-sectional study with data collected from Tongliao City, Inner Mongolia Autonomous Region of China. Diagnostic delays were defined with a cutoff of 30, 60, and 90 days. In different delay groups, risk factors of diagnostic delays were analyzed by univariate analysis and modeled by multivariate logistic regression analysis. A total of 14,506 cases were collected between January 1, 2005, and December 31, 2017, of which the median diagnostic delays was 29 days [interquartile range (IQR): 14–54 days]. Logistic regression analysis indicated that the older age category was associated with longer diagnostic delays across all groups. Longer diagnostic delays increase with age among three delay groups (p for trend <0.001). Occupation as herdsman was associated with shorter diagnostic delays in group 1 with 30 days [adjusted odds ratio (aOR), 0.890 (95% CI 0.804–0.986)]. Diagnostic delays was shorter in patients with brucellosis who were reported in CDC in all delay groups [aOR 0.738 (95% CI 0.690–0.790), 0.539 (95% CI 0.497–0.586), and 0.559 (95% CI 0.504–0.621)]. Pastoral/agricultural area was associated with shorter diagnostic delays in group 1 with 30 days [aOR, 0.889 (95%CI 0.831–0.951)] and group 3 with 90 days [aOR, 0.806 (95%CI 0.727–0.893)]. Stratified analysis showed that the older age category was associated with an increased risk of a long delay in both genders (p < 0.05). The older age group-to-youth group OR increased along with increased delay time (p for trend <0.001). Furthermore, the pastoral/agricultural area was associated with a shorter delay in males (p < 0.05). Delays exist in the diagnosis of HB. We should pay great attention to the risk factors of diagnostic delays, such as older population, non-herdsman, non-pastoral/agricultural area, non-disease prevention, and control agencies. Effective measures should shorten the diagnostic delays, achieve early detection, diagnosis, and treatment, and reduce the risk of HB's chronicity, complications, and economic burden.
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Affiliation(s)
- Jingbo Zhai
- Innovative Institute of Zoonoses, Inner Mongolia University for Nationalities, Tongliao, China
| | - Ruihao Peng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ying Wang
- Plague and Brucellosis Prevention and Control Base, Chinese Center for Disease Control and Prevention, Baicheng, China
| | - Yuying Lu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Huaimin Yi
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jinling Liu
- Key Laboratory of Livestock Infectious Diseases, Ministry of Education, Shenyang Agricultural University, Shenyang, China
| | - Jiahai Lu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zeliang Chen
- Innovative Institute of Zoonoses, Inner Mongolia University for Nationalities, Tongliao, China.,Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Livestock Infectious Diseases, Ministry of Education, Shenyang Agricultural University, Shenyang, China.,Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, China
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Türkkani MH, Özdemir T, Özdilekcan Ç. Determination of related factors about diagnostic and treatment delays in patients with smear-positive pulmonary tuberculosis in Turkey. Turk J Med Sci 2020; 50:1371-1379. [PMID: 32421283 PMCID: PMC7491262 DOI: 10.3906/sag-2001-89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background/aim This study aimed to analyze delays in diagnosis and treatment by defining the related demographic and clinical factors, to reveal obstacles, and to develop essential attempts to help reduce treatment delays. Materials and methods We created a questionnaire on the subject of delays in diagnosis and treatment in tuberculosis (TB) control to be administered to the patients. The forms were distributed to dispensaries across the country by the General Directorate of Public Health via an official letter. Results The study included 853 new patients with smear-positive pulmonary TB. The mean patient delay was 18.06 ± 22.27 days, the mean diagnosis delay was 35.63 ± 34.86 days, and the mean treatment delay was 0.90 ± 2.39 days. We found no association between sex, age, literacy, residential location, the presence of chronic respiratory diseases, and patient delay. It was determined that patient delay was shorter for patients with hemoptysis, fever, dyspnoea, and chest pain. In women, the diagnosis delay was longer than in men. Conclusion In the diagnosis process of patients with tuberculosis, it was determined that there was an improvement in the patient delay; however, the improvement in the diagnosis delay was still not acceptable as an ideal duration.
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Affiliation(s)
| | - Tarkan Özdemir
- Department of Chest Diseases, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Çiğdem Özdilekcan
- Department of Chest Diseases, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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