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Malta G, Serra N, Spatola GF, Maida CM, Graziano G, Di Raimondo D, Fasciana TMA, Caputo V, Giammanco A, Capuano A, Sergi CM, Cascio A, Di Carlo P. The Impact of the Seasonal and Geographical Distribution of Tuberculosis in Sicily: A 6-Year Retrospective Study (2018-2023). J Clin Med 2024; 13:3546. [PMID: 38930075 PMCID: PMC11204755 DOI: 10.3390/jcm13123546] [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: 05/18/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Tuberculosis (TB) continues to be a major public health issue, with high mortality rates reported worldwide. It is worth noting that most of the hospitalizations for tuberculosis in the Sicilian region involve Italian-born individuals, underscoring the need to address this problem. Recent research on the geographic area and seasonality of infectious diseases, including tuberculosis, may aid in developing effective preventive measures. Objectives: This study aimed to evaluate the impact of the season and geographical area on tuberculosis disease prevalence in the Sicilian region. Methods: A retrospective study from January 2018 to May 2023 was conducted on patients with tuberculosis in the Sicilian region by analyzing computerized records on the Infectious Diseases Information System, currently named the Italian National Notification System (NSIS), of the Epidemiology Unit at Policlinico Paolo Giaccone University Hospital of Palermo and the Regional Reference Laboratory for Tuberculosis Surveillance and Control. Results: Eastern and Western Sicily were the geographical Sicilian areas with the highest frequency of patients with tuberculosis (52.2% and 42.6%, respectively). In comparison, Central Sicily had a significantly lower frequency of patients with tuberculosis (5.2%). Regarding the season, autumn was the season with the highest number of notification cases (28.9%), while spring was the season with the lowest frequency of patients with tuberculosis (19.7%). In autumn, we found significantly fewer patients with tuberculosis from Eastern Sicily (39.3%) and Central Sicily (1.5%), while Western Sicily had more patients with tuberculosis (59.3%). In spring, we found significantly more patients with tuberculosis from Eastern Sicily (64.1%), while Western and Central Sicily had significantly fewer patients with tuberculosis (23.9% and 12%, respectively). The presence of patients with tuberculosis did not significantly differ between geographical regions in summer and winter. Conclusions: Geographical area and seasonality significantly impact the distribution of tuberculosis cases in Sicily. These factors may be linked to different climatic conditions across the various geographical areas considered. Our findings suggest that climate can play a critical role in the spread of airborne infectious diseases, such as tuberculosis.
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Affiliation(s)
- Ginevra Malta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.M.); (C.M.M.); (D.D.R.); (T.M.A.F.); (V.C.); (A.C.); (P.D.C.)
| | - Nicola Serra
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy
| | - Giovanni Francesco Spatola
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, 90127 Palermo, Italy
| | - Carmelo Massimo Maida
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.M.); (C.M.M.); (D.D.R.); (T.M.A.F.); (V.C.); (A.C.); (P.D.C.)
| | - Giorgio Graziano
- Clinical Epidemiology Unit, University Hospital “P. Giaccone”, 90127 Palermo, Italy
| | - Domenico Di Raimondo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.M.); (C.M.M.); (D.D.R.); (T.M.A.F.); (V.C.); (A.C.); (P.D.C.)
| | - Teresa Maria Assunta Fasciana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.M.); (C.M.M.); (D.D.R.); (T.M.A.F.); (V.C.); (A.C.); (P.D.C.)
| | - Valentina Caputo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.M.); (C.M.M.); (D.D.R.); (T.M.A.F.); (V.C.); (A.C.); (P.D.C.)
| | - Anna Giammanco
- School of Medicine and Surgery, University of Palermo, 90127 Palermo, Italy
| | - Angela Capuano
- Department of Emergency, AORN Santobono-Pausilipon, 80122 Naples, Italy
| | - Consolato M. Sergi
- Anatomic Pathology Division, Pediatric Pathologist, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.M.); (C.M.M.); (D.D.R.); (T.M.A.F.); (V.C.); (A.C.); (P.D.C.)
| | - Paola Di Carlo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.M.); (C.M.M.); (D.D.R.); (T.M.A.F.); (V.C.); (A.C.); (P.D.C.)
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Animut Y, Godno AB, Nigatu SG, Abiy SA. Delay in seeking treatment and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel zone, Benishangul Gumuz region, Western Ethiopia. Front Public Health 2024; 12:1356770. [PMID: 38476481 PMCID: PMC10929009 DOI: 10.3389/fpubh.2024.1356770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/29/2024] [Indexed: 03/14/2024] Open
Abstract
Background Tuberculosis is a major global public health problem and a leading cause of morbidity and mortality in Ethiopia. TB prevention and control in low-income countries, such as Ethiopia, face significant challenges, including late detection and treatment initiation. A delay in the initiation of tuberculosis treatment increases the morbidity and mortality of patients and community transmission. Therefore, this study aimed to assess patient delay and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel Zone, Benishangul Gumuz Region, Western Ethiopia. Methods An institution-based cross-sectional study was conducted from March to August 2020 among newly diagnosed pulmonary tuberculosis patients. All pulmonary tuberculosis patients (416) who came to all public health facilities of the Metekel zone for treatment during the period were included. Data were collected through face-to-face interviews using a structured and pretested questionnaire. A multivariable logistic regression was fitted to identify independent factors for delay in seeking treatment among PTB patients. Adjusted odds ratios with 95% CIs were determined, and variables with p values <0.05 were considered statistically significant. Results Nearly three-fourths 302 (72.6, 95% CI: 68.5, 76.7) of the patients were delayed in seeking medical advice, with a median patient delay of 27 days (IQR: 21-31). Age of the patients [above 54 years (AOR = 2.65, 95% CI: 1.30, 5.40), 36-54 years (AOR = 1.86, 95% CI: 1.14,3.02)], family size of 5 members and above (AOR = 1.62, 95% CI: 1.10-3.14), travel time above 60 min (AOR = 3.65, 95% CI: 1.55, 8.60), history of visits to informal care providers (AOR = 1.74, 95% CI: 1.11, 3.14), and poor knowledge about PTB (AOR = 1.64, 95% CI: 1.04-2.44) were statistically significant factors associated with delays in seeking treatment among PTB patients. Conclusion Most pulmonary tuberculosis patients delay seeking medical advice for their illnesses. Delays in seeking treatment were associated with older age, large household size, longer travel time to reach the nearby health facility, visiting informal care providers, and poor knowledge about pulmonary tuberculosis. Hence, it is crucial to consider community screening programs, enhance public awareness, and ensure the accessibility of TB diagnostic and treatment services.
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Affiliation(s)
- Yaregal Animut
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abera Birhanu Godno
- Public Health Emergency Management Directorate, Benishangul Gumuz Regional Health Bureau, Assosa, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Saron Abeje Abiy
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Getiye A, Zakaria HF, Deressa A, Mamo G, Gamachu M, Birhanu A, Eyeberu A, Debela A, Hawulte B, Tesfaye G, Mussa I. Magnitude and factors associated with delay in treatment-seeking among new pulmonary tuberculosis patients in public health facilities in Habro district, eastern Ethiopia. Health Serv Insights 2024; 17:11786329241232532. [PMID: 38406176 PMCID: PMC10893885 DOI: 10.1177/11786329241232532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Background In developing nations, almost two-thirds of people with active tuberculosis (TB) remain undetected and untreated. Delays in seeking treatment increase the severity of the illness, the likelihood of mortality, and the risk of the infection spreading to others in the community. Thus, this study aimed to assess the magnitude of delay in treatment-seeking and its associated factors among new adult pulmonary tuberculosis patients attending public health facilities in Habro District, West Harerge Zone, Oromia Region, Eastern Ethiopia. Methods A health facility-based cross-sectional study design was conducted among 420 randomly selected patients with pulmonary tuberculosis who visited public health facilities in Habro District from September 5 to October 5, 2022. Binary logistic regression analysis was used to determine the relationship between the dependent and independent variables, and a 95% confidence interval was used to select significant variables. Result Twenty-one days after the start of their illness, 62.38% (95% CI: 57.4%, 66.6%) of the patients sought an initial consultation. Being female (AOR = 2.14, 95% CI: 1.26, 3.65), having poor knowledge about TB (AOR = 3.10, 95% CI: 1.77, 5.43), having no contact history with TB patients (AOR = 3.52, 95% CI: 1.29, 9.58), having clinically diagnosed pulmonary tuberculosis (AOR = 2.16, 95% CI: 1.26, 3.67), and living a long distance from the nearest health facility (AOR = 2.87, 95% CI: 1.31, 6.23) were important predictors contributing to TB patient treatment delay. Conclusion In the current study, more than three-fifths of TB patients delayed seeking treatment. Thus, awareness of tuberculosis should be created, especially targeting females and communities found at a distance from the health facility. Additionally, health professionals should emphasise the importance of getting medical attention early and knowing how to suspect and identify tuberculosis symptoms.
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Affiliation(s)
- Assefa Getiye
- Habro Woreda Health Office, West Hararge, Oromia Region, Eastern Ethiopia
| | - Hamdi Fekredin Zakaria
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Deressa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Galana Mamo
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mulugeta Gamachu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debela
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Behailu Hawulte
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gezahegne Tesfaye
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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de Morais M, Sousa S, Marques J, Moniz M, Duarte R, Leite A, Soares P. Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal. BMC Public Health 2023; 23:2421. [PMID: 38053129 PMCID: PMC10696854 DOI: 10.1186/s12889-023-17319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Diagnosis delay contributes to increased tuberculosis (TB) transmission and morbimortality. TB incidence has been decreasing in Portugal, but median patient delay (PD) has risen. Symptom valorisation may determine PD by influencing help-seeking behaviour. We aimed to analyse the association between symptom valorisation and PD, while characterising individuals who disregarded their symptoms. METHODS A cross-sectional study was conducted among TB patients in Lisbon and Oporto in 2019 - 2021. Subjects who delayed seeking care because they did not value their symptoms or thought these would go away on their own were considered to have disregarded their symptoms. PD was categorised using a 21-day cut-off, and a 30-day cut-off for sensitivity analysis. We estimated the effect of symptom valorisation on PD through a directed acyclic graph. Then, a multivariable regression analysis characterised patients that disregarded their symptoms, adjusting for relevant variables. We fitted Poisson regression models to estimate crude and adjusted prevalence ratios (PR). RESULTS The study included 75 patients. Median PD was 25 days (IQR 11.5-63.5), and 56.0% of participants had PD exceeding 21 days. Symptom disregard was reported by 38.7% of patients. Patients who did not value their symptoms had higher prevalence of PD exceeding 21 days compared to those who valued their symptoms [PR 1.59 (95% CI 1.05-2.42)]. The sensitivity analysis showed consistent point estimates but wider confidence intervals [PR 1.39 (95% CI 0.77-2.55)]. Being a smoker was a risk factor for symptom disregard [PR 2.35 (95% CI 1.14-4.82)], while living in Oporto [PR 0.35 (95% CI 0.16-0.75)] and having higher household incomes [PR 0.39 (95% CI 0.17-0.94)] were protective factors. CONCLUSIONS These findings emphasise the importance of symptom valorisation in timely TB diagnosis. Patients who did not value their symptoms had longer PD, indicating a need for interventions to improve symptom recognition. Our findings also corroborate the importance of the socioeconomic determinants of health, highlighting tobacco as a risk factor both for TB and for PD.
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Affiliation(s)
- Margarida de Morais
- NOVA National School of Public Health, Public Health Research Centre, NOVA University Lisbon, Lisbon, Portugal.
- Central Lisbon Public Health Unit, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal.
| | - Sofia Sousa
- Multidisciplinary Unit for Biomedical Research, Biomedical Sciences Institute Abel Salazar, University of Porto, Oporto, Portugal
| | - Jéssica Marques
- NOVA National School of Public Health, Public Health Research Centre, NOVA University Lisbon, Lisbon, Portugal
| | - Marta Moniz
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, NOVA University Lisbon, Lisbon, Portugal
| | - Raquel Duarte
- Epidemiological Investigation Unit, Public Health Institute, University of Porto, Oporto, Portugal
- Laboratory for Integrative and Translational Investigation in Populational Health, Oporto, Portugal
- Biomedical Sciences Institute Abel Salazar, University of Porto, Oporto, Portugal
- Clinical Investigation Unit, Regional Health Administration of the North, Oporto, Portugal
- Pneumology Service, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, NOVA University Lisbon, Lisbon, Portugal
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Patrícia Soares
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, NOVA University Lisbon, Lisbon, Portugal
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
- Centre for Vectors and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Águas de Moura, Portugal
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Kidy F, McCarthy N, Seers K. From symptom onset to treatment initiation: protocol for a narrative study exploring the journey of older adults with tuberculosis in the English Midlands, UK. BMJ Open 2023; 13:e070933. [PMID: 37977875 PMCID: PMC10660672 DOI: 10.1136/bmjopen-2022-070933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Time from symptom onset to treatment initiation in tuberculosis (TB) remains stubbornly prolonged despite reductions in disease incidence. Delays may contribute to increased morbidity, mortality, onward spread of disease and poor patient experiences. Most delays occur prior to hospital referral. The average primary care healthcare provider in England is unlikely to see TB on a regular basis. Little is known about primary care diagnostic and referral challenges.Adults aged 65 years or older are more likely to experience delays. However, little is known about their journey from symptom onset to treatment initiation. METHODS AND ANALYSIS We will carry out a narrative study including adults aged 65 years or older, living in the English Midlands and receiving treatment for active TB. Twelve English and 12 Urdu or Punjabi speakers will be recruited from TB clinics and interviewed. Their primary care records will be accessed, and the primary care story and secondary care letters will be extracted. Each of the data sources will be analysed using dialogical narrative analysis. Data will be triangulated within participants and across the data set. ETHICS AND DISSEMINATION This study received approval from the Health Research Authority and the Research Ethics Committee in April 2022. Risk management and equity considerations have been made a priority. Findings will be disseminated through publication in open access peer-reviewed journals, presentations to policy makers, primary healthcare and secondary healthcare professionals, and through public facing materials developed in conjunction with patients, members of the pubic, TB services and charities.
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Affiliation(s)
- Farah Kidy
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Noel McCarthy
- Population Health Medicine, Public Health & Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
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Kang W, Yu J, Liang C, Wang Q, Li L, Du J, Chen H, Liu J, Ma J, Li M, Qin J, Shu W, Zong P, Zhang Y, Yan X, Yang Z, Mei Z, Deng Q, Wang P, Han W, Wu M, Chen L, Zhao X, Tan L, Li F, Zheng C, Liu H, Li X, A. E, Du Y, Liu F, Cui W, Yang S, Chen X, Han J, Xie Q, Feng Y, Liu W, Tang P, Zhang J, Zheng J, Chen D, Yao X, Ren T, Li Y, Li Y, Wu L, Song Q, Yang M, Zhang J, Liu Y, Guo S, Yan K, Shen X, Lei D, Zhang Y, Li Y, Dong Y, Tang S. Epidemiology and Association Rules Analysis for Pulmonary Tuberculosis Cases with Extrapulmonary Tuberculosis from Age and Gender Perspective: A Large-Scale Retrospective Multicenter Observational Study in China. Int J Clin Pract 2023; 2023:5562495. [PMID: 37609664 PMCID: PMC10442182 DOI: 10.1155/2023/5562495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 08/24/2023] Open
Abstract
Background Tuberculosis (TB), a multisystemic disease with protean presentation, remains a major global health problem. Although concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) cases are commonly observed clinically, knowledge regarding concurrent PTB-EPTB is limited. Here, a large-scale multicenter observational study conducted in China aimed to study the epidemiology of concurrent PTB-EPTB cases by diagnostically defining TB types and then implementing association rules analysis. Methods The retrospective study was conducted at 21 hospitals in 15 provinces in China and included all inpatients with confirmed TB diagnoses admitted from Jan 2011 to Dec 2017. Association rules analysis was conducted for cases with concurrent PTB and various types of EPTB using the Apriori algorithm. Results Evaluation of 438,979TB inpatients indicated PTB was the most commonly diagnosed (82.05%) followed by tuberculous pleurisy (23.62%). Concurrent PTB-EPTB was found in 129,422 cases (29.48%) of which tuberculous pleurisy was the most common concurrent EPTB type observed. The multivariable logistic regression models demonstrated that odds ratios of concurrent PTB-EPTB cases varied by gender and age group. For PTB cases with concurrent EPTB, the strongest association was found between PTB and concurrent bronchial tuberculosis (lift = 1.09). For EPTB cases with concurrent PTB, the strongest association was found between pharyngeal/laryngeal tuberculosis and concurrent PTB (lift = 1.11). Confidence and lift values of concurrent PTB-EPTB cases varied with gender and age. Conclusions Numerous concurrent PTB-EPTB case types were observed, with confidence and lift values varying with gender and age. Clinicians should screen for concurrent PTB-EPTB in order to improve treatment outcomes.
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Affiliation(s)
- Wanli Kang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Jiajia Yu
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Chen Liang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Quanhong Wang
- Taiyuan Fourth People's Hospital, Number 231, Xikuang Street, Wanbailin District, Taiyuan, Shanxi 030024, China
| | - Liang Li
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Jian Du
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Hongyan Chen
- Shenyang Chest Hospital, No. 11 Beihai Street, Dadong District, Shenyang110044, China
| | - Jianxiong Liu
- Guang Zhou Chest Hospital, No. 62, Heng Zhi Gang Road, Yuexiu District, Guangzhou, Guangdong 510095, China
| | - Jinshan Ma
- Chest Hospital of Xinjiang, No. 106, Yan ‘An Road, Tianshan District, Urumqi, Xinjiang 830049, China
| | - Mingwu Li
- The Third People's Hospital of Kunming, No. 319 Wu Jing Road, Kunming, Yunnan 650041, China
| | - Jingmin Qin
- Shandong Provincial Chest Hospital, No. 12, Lieshishandong Road, Licheng District, Jinan, Shandong 250000, China
| | - Wei Shu
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Peilan Zong
- Jiangxi Chest (Third People) Hospital, No. 346 Dieshan Road, Donghu District, Nanchang, Jiangxi 330006, China
| | - Yi Zhang
- Chang Chun Infectious Diseases Hospital, No. 2699, Sandao Section, Changji South Line, Erdao District, Changchun, Jilin 130123, China
| | - Xiaofeng Yan
- Chongqing Public Health Medical Center, No. 109, Baoyu Road, Geleshan Town, Shapingba District, Chongqing 400036, China
| | - Zhiyi Yang
- Fuzhou Pulmonary Hospital of Fujian, No. 2, Lakeside, Cangshan District, Fuzhou 350008, China
| | - Zaoxian Mei
- Tianjin Haihe Hospital, Number 890, Shuanggangzhenjingu Road, Jinnan District, Tianjin 300350, China
| | - Qunyi Deng
- Third People's Hospital of Shenzhen, 29 Bulan Road, District Longgang, Shenzhen 518112, China
| | - Pu Wang
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Wenge Han
- Weifang No. 2 People's Hospital, No. 7th Yuanxiao Street, Kuiwen District 261041, China
| | - Meiying Wu
- The Fifth People's Hospital of Suzhou, No. 10 Guangqian Road, Suzhou, Jiangsu 215000, China
| | - Ling Chen
- Affiliated Hospital of Zunyi Medical College, No. 149 Delian Road, Zunyi, Guizhou 563000, China
| | - Xinguo Zhao
- The Fifth People's Hospital of Wuxi, No. 1215, GuangRui Road, Wuxi 214001, China
| | - Lei Tan
- TB Hospital of Siping City, No. 10 Dongshan Road, Tiedong District, Siping, Jilin Province 136001, China
| | - Fujian Li
- Baoding Hospital for Infectious Disease, No. 608 Dongfeng East Road, Lianchi District, Baoding, Hebei 071000, China
| | - Chao Zheng
- The First Affiliated of XiaMen University, ZhenhaiRoud, Siming District, Xiamen, Fujian, China
| | - Hongwei Liu
- Shenyang Chest Hospital, No. 11 Beihai Street, Dadong District, Shenyang110044, China
| | - Xinjie Li
- Guang Zhou Chest Hospital, No. 62, Heng Zhi Gang Road, Yuexiu District, Guangzhou, Guangdong 510095, China
| | - Ertai A.
- Chest Hospital of Xinjiang, No. 106, Yan ‘An Road, Tianshan District, Urumqi, Xinjiang 830049, China
| | - Yingrong Du
- The Third People's Hospital of Kunming, No. 319 Wu Jing Road, Kunming, Yunnan 650041, China
| | - Fenglin Liu
- Shandong Provincial Chest Hospital, No. 12, Lieshishandong Road, Licheng District, Jinan, Shandong 250000, China
| | - Wenyu Cui
- Chang Chun Infectious Diseases Hospital, No. 2699, Sandao Section, Changji South Line, Erdao District, Changchun, Jilin 130123, China
| | - Song Yang
- Chongqing Public Health Medical Center, No. 109, Baoyu Road, Geleshan Town, Shapingba District, Chongqing 400036, China
| | - Xiaohong Chen
- Fuzhou Pulmonary Hospital of Fujian, No. 2, Lakeside, Cangshan District, Fuzhou 350008, China
| | - Junfeng Han
- Tianjin Haihe Hospital, Number 890, Shuanggangzhenjingu Road, Jinnan District, Tianjin 300350, China
| | - Qingyao Xie
- Third People's Hospital of Shenzhen, 29 Bulan Road, District Longgang, Shenzhen 518112, China
| | - Yanmei Feng
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Wenyu Liu
- Weifang No. 2 People's Hospital, No. 7th Yuanxiao Street, Kuiwen District 261041, China
| | - Peijun Tang
- The Fifth People's Hospital of Suzhou, No. 10 Guangqian Road, Suzhou, Jiangsu 215000, China
| | - Jianyong Zhang
- Affiliated Hospital of Zunyi Medical College, No. 149 Delian Road, Zunyi, Guizhou 563000, China
| | - Jian Zheng
- The Fifth People's Hospital of Wuxi, No. 1215, GuangRui Road, Wuxi 214001, China
| | - Dawei Chen
- Baoding Hospital for Infectious Disease, No. 608 Dongfeng East Road, Lianchi District, Baoding, Hebei 071000, China
| | - Xiangyang Yao
- The First Affiliated of XiaMen University, ZhenhaiRoud, Siming District, Xiamen, Fujian, China
| | - Tong Ren
- Shenyang Chest Hospital, No. 11 Beihai Street, Dadong District, Shenyang110044, China
| | - Yan Li
- Guang Zhou Chest Hospital, No. 62, Heng Zhi Gang Road, Yuexiu District, Guangzhou, Guangdong 510095, China
| | - Yuanyuan Li
- Chest Hospital of Xinjiang, No. 106, Yan ‘An Road, Tianshan District, Urumqi, Xinjiang 830049, China
| | - Lei Wu
- The Third People's Hospital of Kunming, No. 319 Wu Jing Road, Kunming, Yunnan 650041, China
| | - Qiang Song
- Shandong Provincial Chest Hospital, No. 12, Lieshishandong Road, Licheng District, Jinan, Shandong 250000, China
| | - Mei Yang
- Taiyuan Fourth People's Hospital, Number 231, Xikuang Street, Wanbailin District, Taiyuan, Shanxi 030024, China
| | - Jian Zhang
- Chang Chun Infectious Diseases Hospital, No. 2699, Sandao Section, Changji South Line, Erdao District, Changchun, Jilin 130123, China
| | - Yuanyuan Liu
- Tianjin Haihe Hospital, Number 890, Shuanggangzhenjingu Road, Jinnan District, Tianjin 300350, China
| | - Shuliang Guo
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Kun Yan
- Weifang No. 2 People's Hospital, No. 7th Yuanxiao Street, Kuiwen District 261041, China
| | - Xinghua Shen
- The Fifth People's Hospital of Suzhou, No. 10 Guangqian Road, Suzhou, Jiangsu 215000, China
| | - Dan Lei
- Affiliated Hospital of Zunyi Medical College, No. 149 Delian Road, Zunyi, Guizhou 563000, China
| | - Yanli Zhang
- Baoding Hospital for Infectious Disease, No. 608 Dongfeng East Road, Lianchi District, Baoding, Hebei 071000, China
| | - Youcai Li
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Yongkang Dong
- Taiyuan Fourth People's Hospital, Number 231, Xikuang Street, Wanbailin District, Taiyuan, Shanxi 030024, China
| | - Shenjie Tang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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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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8
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Arja A, Bogale B, Gebremedhin M. Health system delay and its associated factors among tuberculosis patients in Gamo Zone public health facilities, Southern Ethiopia: An institution-based cross-sectional study. J Clin Tuberc Other Mycobact Dis 2022; 28:100325. [PMID: 35813285 PMCID: PMC9257408 DOI: 10.1016/j.jctube.2022.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background Delayed tuberculosis (TB) diagnosis and treatment increase morbidity, mortality, expenditure, and transmission in the community. Early diagnosis and initiation of treatment are essential for effective TB control. Objective The main objective of this study was to assess the magnitude and factors associated with health system delay among tuberculosis patients in Gamo Zone, Southern Ethiopia. Methods A cross-sectional study was conducted in Gamo Zone, Southern Ethiopia from February to April 2019. Fifteen health facilities in the study area were selected randomly and 255 TB patients who were ≥ 18 years of age were included. Data were collected using a questionnaire through face-to-face interviews and analyzed using SPSS version 20.0. Health system delay was analyzed using the median as a cut-off. Logistic regression analysis was performed to investigate factors of delays. A p-value of ≤ 0.05 at multivariable analysis was considered statistically significant. Results The median (inter-quartile range) of health system delays was 14(6-30) days. About 54.5% of patients had prolonged health system delays. Patients who had multiple healthcare contacts (AOR: 5.74; 95% CI: 2.47, 13.34) and aged between 25 and 44 years old (AOR: 1.98; 95% CI: 1.02, 3.86) and aged ≥ 45 years (AOR: 3.54; 95% CI: 2.17, 14.27) were significantly associated with longer health system's delay. However, female gender (AOR: 0.46; 95% CI: 0.25, 0.87) and patients presenting symptoms [Hemoptysis (AOR: 0.27; 95%CI: 0.11, 0.65) and Chest pain (AOR: 0.28; 95%CI; 0.14, 0.56)] were significantly associated with reduced health system's delay. Conclusion In this study, it was observed that a significant proportion of patients experienced more than the acceptable level for health system delay. The number of health care contact, presenting symptoms, age and sex were factors associated with health system delay. Hence, increasing clinician awareness of TB clinical presentation, implementing systems enabling early case detection, and ensuring rapid diagnosis of TB are required to achieve further TB control. Finally, maintenance of a high index of suspicion for tuberculosis in the vulnerable population could reduce long health system delays in the management of TB.
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Affiliation(s)
- Asrat Arja
- Department of Data Repository and Governance, National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Biruk Bogale
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Mesfin Gebremedhin
- Arba Minch University, College of Medicine & Health Sciences, Department of Public Health, Arba Minch, Ethiopia
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9
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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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10
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O’Connell J, Reidy N, McNally C, de Barra E, Stanistreet D, McConkey S. Delayed Tuberculosis Treatment and Cost of Care in a Low-Incidence Country. Open Forum Infect Dis 2022; 9:ofac164. [PMID: 35611347 PMCID: PMC9124588 DOI: 10.1093/ofid/ofac164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background Tuberculosis (TB) elimination requires high-quality, timely care. In countries with a low incidence of TB, such as Ireland, delayed diagnosis is common. This evaluation aimed to determine the factors that predict patient-related and health care provider–related delays in TB management and to establish how TB care cost is affected by care delays. Methods Health care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1, 2018, and December 31, 2019, were reviewed to measure and determine predictors of patient-related delays, health care provider–related delays, and the cost of TB care. Outcomes were compared against benchmarks derived from the literature. Results Thirty-seven patients were diagnosed with TB, and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider–related delay among patients with PTB was 16 days and, although similar to the benchmark (median, 22 days; minimum, 11 days; maximum, 36 days), could be improved. The health care provider–related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298 and, while similar to that reported in the literature (median, €9319; minimum, €6486; maximum, €14 750), could be improved. Patient-related delays among those with PTB predicted care costs. Conclusions Patient-related and health care provider–related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.
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Affiliation(s)
- James O’Connell
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Dublin, Ireland
| | - Niamh Reidy
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Dublin, Ireland
| | - Cora McNally
- Beaumont Hospital, Health Service Executive, Beaumont, Dublin 9, Ireland
| | - Eoghan de Barra
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Dublin, Ireland
- Beaumont Hospital, Health Service Executive, Beaumont, Dublin 9, Ireland
| | - Debbi Stanistreet
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Dublin, Ireland
| | - Samuel McConkey
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Dublin, Ireland
- Beaumont Hospital, Health Service Executive, Beaumont, Dublin 9, Ireland
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11
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Arja A, Godana W, Hassen H, Bogale B. Patient delay and associated factors among tuberculosis patients in Gamo zone public health facilities, Southern Ethiopia: An institution-based cross-sectional study. PLoS One 2021; 16:e0255327. [PMID: 34329333 PMCID: PMC8323940 DOI: 10.1371/journal.pone.0255327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 07/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background Delayed tuberculosis diagnosis and treatment increase morbidity, mortality, expenditure, and transmission in the community. Early diagnosis and initiation of treatment are essential for effective TB control. Therefore, the main objective of this study was to assess the magnitude and factors associated with patient delay among tuberculosis patients in Gamo Zone, Southern Ethiopia. Methods A cross-sectional study was conducted in Gamo Zone, Southern Ethiopia from February to April 2019. Fifteen health facilities of the study area were selected randomly and 255 TB patients who were ≥18 years of age were included. Data were collected using a questionnaire through face-to-face interviews and analyzed using SPSS version 20.0. Patient delay was analyzed using the median as the cut-off value. Multivariable logistic regression analysis was fitted to identify factors associated with patient delay. A p-value of ≤ 0.05 with 95% CI was considered to declare a statistically significant association. Results The median (inter-quartile range) of the patient delay was 30 (15–60) days. About 56.9% of patients had prolonged patients’ delay. Patient whose first contact were informal provider (adjusted odds ratio [AOR]: 2.24; 95% confidence interval [CI] 1.29, 3.86), presenting with weight loss (AOR: 2.53; 95%CI: 1.35, 4.74) and fatigue (AOR: 2.38; 95%CI: 1.36, 4.17) and body mass index (BMI) categories of underweight (AOR: 1.74; 95%CI: 1.01, 3.00) were independently associated with increased odds of patient delay. However, having good knowledge about TB (AOR: 0.44; 95% CI: 0.26, 0.76) significantly reduce patients’ delay. Conclusion In this study, a significant proportion of patients experienced more than the acceptable level for the patient delay. Knowledge about TB, the first action to illness, presenting symptoms, and BMI status were identified factors associated with patient delay. Hence, raising public awareness, regular training, and re-training of private and public healthcare providers, involving informal providers, and maintenance of a high index of suspicion for tuberculosis in the vulnerable population could reduce long delays in the management of TB.
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Affiliation(s)
- Asrat Arja
- Bursa District Health Office, Bursa, Sidama Region, Ethiopia
- * E-mail:
| | - Wanzahun Godana
- Schools of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Hadiya Hassen
- Schools of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Biruk Bogale
- Departments of Public Health, Mizan Tepi University, Mizan Aman, Ethiopia
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12
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Fabiani M, Mateo-Urdiales A, Andrianou X, Bella A, Del Manso M, Bellino S, Rota MC, Boros S, Vescio MF, D'Ancona FP, Siddu A, Punzo O, Filia A, Brusaferro S, Rezza G, Dente MG, Declich S, Pezzotti P, Riccardo F. Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system. Eur J Public Health 2021; 31:37-44. [PMID: 33416859 PMCID: PMC7851886 DOI: 10.1093/eurpub/ckaa249] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND International literature suggests that disadvantaged groups are at higher risk of morbidity and mortality from SARS-CoV-2 infection due to poorer living/working conditions and barriers to healthcare access. Yet, to date, there is no evidence of this disproportionate impact on non-national individuals, including economic migrants, short-term travellers and refugees. METHODS We analyzed data from the Italian surveillance system of all COVID-19 laboratory-confirmed cases tested positive from the beginning of the outbreak (20th of February) to the 19th of July 2020. We used multilevel negative-binomial regression models to compare the case fatality and the rate of admission to hospital and intensive care unit (ICU) between Italian and non-Italian nationals. The analysis was adjusted for differences in demographic characteristics, pre-existing comorbidities, and period of diagnosis. RESULTS We analyzed 213 180 COVID-19 cases, including 15 974 (7.5%) non-Italian nationals. We found that, compared to Italian cases, non-Italian cases were diagnosed at a later date and were more likely to be hospitalized {[adjusted rate ratio (ARR)=1.39, 95% confidence interval (CI): 1.33-1.44]} and admitted to ICU (ARR=1.19, 95% CI: 1.07-1.32), with differences being more pronounced in those coming from countries with lower human development index (HDI). We also observed an increased risk of death in non-Italian cases from low-HDI countries (ARR=1.32, 95% CI: 1.01-1.75). CONCLUSIONS A delayed diagnosis in non-Italian cases could explain their worse outcomes compared to Italian cases. Ensuring early access to diagnosis and treatment to non-Italians could facilitate the control of SARS-CoV-2 transmission and improve health outcomes in all people living in Italy, regardless of nationality.
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Affiliation(s)
- Massimo Fabiani
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Alberto Mateo-Urdiales
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Xanthi Andrianou
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy.,International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Antonino Bella
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Martina Del Manso
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Stefania Bellino
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Maria C Rota
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Boros
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Maria F Vescio
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | | | - Andrea Siddu
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Ornella Punzo
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Antonietta Filia
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | | | - Giovanni Rezza
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Maria G Dente
- Centro Nazionale per la Salute Globale, Istituto Superiore di Sanità, Rome, Italy
| | - Silvia Declich
- Centro Nazionale per la Salute Globale, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Riccardo
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
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Gong HZ, Han C, Yang FL, Wang CF, Wang JL, Wang MS. Treatment delay in childhood pleural tuberculosis and associated factors. BMC Infect Dis 2020; 20:793. [PMID: 33109109 PMCID: PMC7590447 DOI: 10.1186/s12879-020-05496-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background Delay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances the transmission of tuberculosis (TB) in the community. Therefore, this study aims to assess treatment delay and its associated factors among childhood pleural TB patients in China. Methods Between January 2006 and December 2019, consecutive patients aged ≤15 years with definite or possible pleural TB were included for analysis. Treatment delay duration was defined as the time interval from the onset of symptoms to treatment initiation and was stratified into two categories: < 30 days, ≥30 days (median delay day is 30 days). The electronic medical records of children were reviewed to obtain demographic characteristics, clinical characteristics, laboratory examinations, and radiographic findings. Univariate and multivariate logistic regressions were used to explore the factors associated with treatment delay in patients. Results A total of 154 children with pleural TB were included, with a mean age of 12.4 ± 3.3 years. The median treatment delay was 30 days (interquartile range, 10–60 days) and 51.3% (n = 79) of patients underwent a treatment delay. Multivariate analysis revealed that heart rate (≤92 beats/min, age-adjusted OR = 2.503, 95% CI: 1.215, 5.155) and coefficient of variation of red cell distribution width (RDW-CV, ≥12.9%, age-adjusted OR = 4.705, 95% CI: 2.048, 10.811) were significant risk factors for treatment delays in childhood pleural TB. Conclusion Our findings suggested that a significant treatment delay occurs among children with pleural TB in China. Patients with a low heart rate or a high RDW-CV experienced delays in the initiation of anti-TB therapy. Therefore, well awareness of the associations between clinical characteristics and treatment delay may improve the management of children with pleural TB and enable us to develop preventive strategies to reduce the treatment delay. Supplementary information Supplementary information accompanies this paper at 10.1186/s12879-020-05496-4.
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Affiliation(s)
- Huai-Zheng Gong
- Department of Lab Medicine, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chao Han
- Department of Geriatrics, Shandong Mental Health Center, Jinan, China
| | - Feng-Lian Yang
- School of Pharmacy, Youjiang Medical University for Nationalities, Baise, China
| | - Chun-Fang Wang
- Department of Lab Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Jun-Li Wang
- Department of Lab Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China.
| | - Mao-Shui Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Der JB, Grint D, Narh CT, Bonsu F, Grant AD. Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana. PLoS One 2020; 15:e0230604. [PMID: 32191768 PMCID: PMC7081980 DOI: 10.1371/journal.pone.0230604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Ghana’s national prevalence survey showed higher than expected tuberculosis (TB) prevalence, indicating that many people with TB are not identified and treated. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment. Methods A prospective cohort study was conducted in urban and rural health facilities in south-east Ghana. Consecutive patients routinely identified as needing a TB test were followed up for two months to find out if sputum was submitted and/or treatment started. The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression. Results A total of 428 persons (mean age 48 years, 67.3% female) were recruited, 285 (66.6%) from urban and 143 (33.4%) from rural facilities. Of 410 (96%) individuals followed up, 290 (70.7%) submitted sputum, among which 27 (14.1%) had a positive result and started treatment. Among those who visited an urban facility, 245/267(91.8%) submitted sputum, compared to 45/143 (31.5%) who visited a rural facility. Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84–42.51). After adjustment for confounding, there was still a strong association between attending the urban facility and submitting sputum (adjusted OR (aOR) 9.52, 95%CI 3.87–23.40). Travel distance of >10 km to the laboratory was the strongest predictor of not submitting sputum (aOR 0.12, 95%CI 0.05–0.33). Conclusion The majority of presumptive TB patients attending a rural health facility did not submit sputum for testing, mainly due to the long travel distance to the laboratory. Bridging this gap in the diagnostic cascade may improve case detection.
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Affiliation(s)
- Joyce B. Der
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- * E-mail:
| | - Daniel Grint
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clement T. Narh
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg – University Mainz, Mainz, Germany
| | - Frank Bonsu
- Department of Disease Control and Prevention, National TB Control Program, Ghana Health Service, Accra, Ghana
| | - Alison D. Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Sikkhajan Y, Sirichokchatchawan W. Factors associated with patient delay among tuberculosis patients in border hospitals, Chiang Rai province, Thailand. JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.1108/jhr-04-2019-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this paper is to determine the factors associated with patient delay among tuberculosis patients in border hospitals, Chiang Rai province, Thailand.
Design/methodology/approach
A cross-sectional study was conducted in the four biggest border hospitals in Chiang Rai province, Thailand during May to July 2018 among 103 identified TB cases. Data were collected by a face-to-face interview with structured questionnaire on patients’ general characteristics, HIV status and patient delay status. Descriptive statistics were used to analyze the patients’ general characteristics, HIV and patient delay status. The association among variables and patient delay was analyzed by χ2-test. The variables with p-value<0.20 obtained in bivariate analysis were further analyzed by binary logistic regression and considered significant with p-value<0.05.
Findings
All patients enrolled, most were reported with patient delay (65.0 percent). Bivariate analysis demonstrated that level of education, nationality and HIV status were associated factors for patient delay. Among these factors, binary logistic regression revealed that HIV negative TB patients were increased 6.806-fold odds of being patient delay (OR = 6.806; 95% CI: 1.174–39.462), while non-Thai TB patients were also increased 2.824-fold odds of being patient delay (OR = 2.824; 95% CI: 1.041–7.660).
Originality/value
Patient delay among TB patients in Chiang Rai province was high. This study further supports the requirement on promoting of TB knowledge and awareness emphasized on non-Thai population and general public along the border areas of Chiang Rai province.
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Wondawek TM, Ali MM. Delay in treatment seeking and associated factors among suspected pulmonary tuberculosis patients in public health facilities of Adama town, eastern Ethiopia. BMC Public Health 2019; 19:1527. [PMID: 31727034 PMCID: PMC6857315 DOI: 10.1186/s12889-019-7886-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low-income countries, delays in treatment seeking among tuberculosis patients contribute to easy transmission and high prevalence of tuberculosis. OBJECTIVE The aim of this study was to determine the magnitude of delays in treatment-seeking and risk factors among pulmonary tuberculosis suspected patients in health facilities located in Adama, Ethiopia. METHOD A health-facility based cross-sectional study was conducted at Adama from December 20, 2015, to March 1, 2016, among 598 tuberculosis suspected patients. Data was collected from all study participants on the same day of tuberculosis diagnosis using a structured questionnaire. Epi-Info 3.5.3 and Statistical package for the social sciences (SPSS) version 16.0 were used for data entry and analysis respectively. A bivariate and multivariable regression model was used to investigate the association between delay in seeking-treatment and various factors. Odds ratio with 95% CI and P-value < 0.05 were considered as cut off point to measure the strength and significance of the association. RESULTS Among 598 pulmonary tuberculosis suspected patients, 79 (13.2%) were smear-positive. Among smear-positive participants, 61(77.2%) delayed seeking treatment and 275 (46%) patients delayed seeking treatment for > 30 days. The following factors were significantly associated with a delay in seeking treatment: female sex OR = 1.57, 95% CI (1.14, 2.18), low monthly income OR = 1.45, 95% CI (1.05, 2.01), lack of knowledge regarding tuberculosis OR = 1.67, 95% CI (1.13, 2.48), and cure rate of tuberculosis OR = 1.836, 95% CI (1.25, 2.69). CONCLUSION Nearly half of pulmonary tuberculosis suspected patients delayed seeking treatment in our study area. Female sex, low income, family size of five and greater, no knowledge about tuberculosis and cure rate were factors contributing to delay in treatment-seeking among suspected tuberculosis patients.
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Affiliation(s)
- Tirusew Maru Wondawek
- Oromia regional health bureau, Adama Public Health Research and referral Laboratory center, Adama, Ethiopia.
| | - Musa Mohammed Ali
- College of Medicine and Health Sciences, School of Medical Laboratory Science, Hawassa University, Hawassa, Ethiopia
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Evenden P, Roche A, Karo B, Balasegaram S, Anderson CS. Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome. BMJ Open Respir Res 2019; 6:e000468. [PMID: 31673368 PMCID: PMC6797301 DOI: 10.1136/bmjresp-2019-000468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/04/2022] Open
Abstract
Background A quarter of London’s pulmonary tuberculosis (TB) patients have over 4 months of delay. Late diagnosis increases disease severity and the risk of transmission. We aim to classify delays, identify associated risk factors and assess treatment outcome. Methods We conducted a retrospective cohort study using London surveillance data, 2012–2018 on adults aged ≥18 years with pulmonary TB. We defined presentation delay (days from symptom onset to first healthcare visit) and healthcare delay (first healthcare visit to treatment commencement) as dichotomous variables; positive delay being days equal or greater than the third quartile. We applied logistic regression models to identify risk factors associated with delays and treatment outcome at 12 months. Results Of 7216 people, 4539 reported presentation and 5193 healthcare delays. The third quartiles for presentation and healthcare delay were 84 and 61 days, respectively. Presentation delay was associated with female sex (adjusted OR (aOR)=1.21; 95% CI 1.04 to 1.39), increasing age (aOR=1.004; 95% CI 1.001 to 1.008), white compared to Asian ethnicity (aOR=1.35; 95% CI 1.12 to 1.62), previous imprisonment (aOR=1.66; 95% CI 1.22 to 2.26) and alcohol misuse (aOR=1.44; 95% CI 1.04 to 1.89). Healthcare delay was associated with female sex (aOR=1.39; 95% CI 1.21 to 1.59), increasing age (aOR=1.014; 95% CI 1.009 to 1.018) and white ethnicity (aOR=1.41; 95% CI 1.19 to 1.68). 16% of 5678 people with known outcome did not complete treatment. Neither delay was associated with non-completion (p value <0.05). Conclusions Female, white and older people with TB were more likely to experience both presentation and healthcare delays. Social risk factors were also associated with delay in presentation. Early diagnosis and treatment remain critical to reduce transmission, regardless of whether delay affected completion.
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Affiliation(s)
- Poppy Evenden
- ANTICPE, INSERM U1086, Caen, France.,Field Service, South East and London, Public Health England, London, UK
| | - Anita Roche
- South London Health Protection Team, Public Health England, London, UK
| | - Basel Karo
- Field Service, South East and London, Public Health England, London, UK.,ECDC, European Centre for Disease Prevention and Control, Solna, Sweden
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