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Rima DD, Legese D, Woldesemayat EM. Tuberculosis treatment delay and associated factors among pulmonary tuberculosis patients at public health facilities in Dale District and Yirgalem Town administration, Sidama Region, South Ethiopia. BMC Infect Dis 2024; 24:517. [PMID: 38783203 PMCID: PMC11112870 DOI: 10.1186/s12879-024-09397-8] [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: 01/01/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) treatment delay is one of the major challenges of TB care in many low-income countries. Such cases may contribute to an increased TB transmission and severity of illness. The aim of this study was to determine the magnitude of patient delay in TB treatment, and associated factors in Dale District and Yirgalem Town administration of Sidama Region, Southern Ethiopia. METHODS Between January 1-Augst 30/ 2022, we studied randomly selected 393 pulmonary TB cases on Directly Observed Treatment Short course (DOTS) in Dale District and Yirgalem Town Administration. After conducting a pretest, we interviewed participants on sociodemographic, health seeking behavior and clinical factors and reviewed the TB registry. Trained enumerators interviewed to collect data. We entered data in to EPI-info 7 version 3.5.4 and then exported to the Statistical Package for Social Science (SPSS) version 23 for analysis. Multivariable logistic regression was used to identify associated factors of TB and statistical significance was defined using the 95% confidence interval. RESULT A total of 393 (98%) participants involved in the study. The magnitude of delay in TB treatment among the study participants was 223 (56.7%) (95% CI (51.8 - 61.6%)). Distance of the health facility from home, (adjusted odds ratio (AOR) = 2.04, 95% CI (1.3, 3.2)), seeking antibiotic treatment before being diagnosed for TB (AOR = 2.1, 95% CI (1.3, 3.5)) and the knowledge of TB prevention and treatments (AOR = 5.9, 95% CI (3.6, 9.8)), were factors associated with delay in TB treatment. CONCLUSION The prevalence of TB treatment delay among pulmonary TB patients in the study setting was high. Delay in TB treatment was associated with knowledge, behavioral and accessibility related factors. Providing health education and active case finding of TB would help in minimizing the delay.
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Affiliation(s)
| | - Derese Legese
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, 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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McNabb KC, Bergman AJ, Patil A, Lowensen K, Mthimkhulu N, Budhathoki C, Perrin N, Farley JE. Travel distance to rifampicin-resistant tuberculosis treatment and its impact on loss to follow-up: the importance of continued RR-TB treatment decentralization in South Africa. BMC Public Health 2024; 24:578. [PMID: 38389038 PMCID: PMC10885440 DOI: 10.1186/s12889-024-17924-0] [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: 11/04/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Understanding why patients experience loss to follow-up (LTFU) is essential for TB control. This analysis examines the impact of travel distance to RR-TB treatment on LTFU, which has yet to be analyzed within South Africa. METHODS We retrospectively analyzed 1436 patients treated for RR-TB at ten South African public hospitals. We linked patients to their residential ward using data reported to NHLS and maps available from the Municipal Demarcation Board. Travel distance was calculated from each patient's ward centroid to their RR-TB treatment site using the georoute command in Stata. The relationship between LTFU and travel distance was modeled using multivariable logistic regression. RESULTS Among 1436 participants, 75.6% successfully completed treatment and 24.4% were LTFU. The median travel distance was 40.96 km (IQR: 17.12, 63.49). A travel distance > 60 km increased odds of LTFU by 91% (p = 0.001) when adjusting for HIV status, age, sex, education level, employment status, residential locale, treatment regimen, and treatment site. CONCLUSION People living in KwaZulu-Natal and Eastern Cape travel long distances to receive RR-TB care, placing them at increased risk for LTFU. Policies that bring RR-TB treatment closer to patients, such as further decentralization to PHCs, are necessary to improve RR-TB outcomes.
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Affiliation(s)
- Katherine C McNabb
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA.
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA.
| | - Alanna J Bergman
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Amita Patil
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Kelly Lowensen
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Nomusa Mthimkhulu
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Port Shepstone, Republic of South Africa
| | - Chakra Budhathoki
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
| | - Jason E Farley
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- Johns Hopkins TB Research Advancement Center, Baltimore, MD, USA
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Akalu TY, Clements ACA, Gebreyohannes EA, Xu Z, Bai L, Alene KA. Risk factors for diagnosis and treatment delay among patients with multidrug-resistant tuberculosis in Hunan Province, China. BMC Infect Dis 2024; 24:159. [PMID: 38308252 PMCID: PMC10835895 DOI: 10.1186/s12879-024-09036-2] [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: 07/12/2023] [Accepted: 01/19/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a global health threat associated with high morbidity and mortality rates. Diagnosis and treatment delays are associated with poor treatment outcomes in patients with MDR-TB. However, the risk factors associated with these delays are not robustly investigated, particularly in high TB burden countries such as China. Therefore, this study aimed to measure the length of diagnosis and treatment delays and identify their risk factors among patients with MDR-TB in Hunan province. METHODS A retrospective cohort study was conducted using MDR-TB data from Hunan province between 2013 and 2018. The main outcomes of the study were diagnosis and treatment delay, defined as more than 14 days from the date of symptom to diagnosis confirmation (i.e., diagnosis delay) and from diagnosis to treatment commencement (i.e., treatment delay). A multivariable logistic regression model was fitted, and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to identify factors associated with diagnosis and treatment delay. RESULTS In total, 1,248 MDR-TB patients were included in this study. The median length of diagnosis delays was 27 days, and treatment delays were one day. The proportion of MDR-TB patients who experienced diagnosis and treatment delay was 62.82% (95% CI: 60.09-65.46) and 30.77% (95% CI: 28.27-33.39), respectively. The odds of experiencing MDR-TB diagnosis delay among patients coming through referral and tracing was reduced by 41% (AOR = 0.59, 95% CI: 0.45-0.76) relative to patients identified through consultations due to symptoms. The odds of experiencing diagnosis delay among ≥ 65 years were 65% (AOR = 0.35, 0.14-0.91) lower than under-15 children. The odds of developing treatment delay among foreign nationalities and people from other provinces were double (AOR = 2.00, 95% CI: 1.31-3.06) compared to the local populations. Similarly, the odds of experiencing treatment delay among severely ill patients were nearly 2.5 times higher (AOR = 2.49, 95% CI: 1.41-4.42) compared to patients who were not severely ill. On the other hand, previously treated TB cases had nearly 40% (AOR = 0.59, 95% CI: 0.42-0.85) lower odds of developing treatment delay compared with new MDR-TB cases. Similarly, other ethnic minority groups had nearly 40% (AOR = 0.57, 95% CI: 0.34-0.96) lower odds of experiencing treatment delay than the Han majority. CONCLUSIONS Many MDR-TB patients experience long diagnosis and treatment delays in Hunan province. Strengthening active case detection can significantly reduce diagnosis delays among MDR-TB patients. Moreover, giving attention to patients who are new to MDR-TB treatment, are severely ill, or are from areas outside Hunan province will potentially reduce the burden of treatment delay among MDR-TB patients.
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Affiliation(s)
- Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, 6102, Australia.
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia.
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Eyob Alemayehu Gebreyohannes
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia
- School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Liqiong Bai
- TB Control Institute of Hunan Province, Changsha, China
| | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, 6102, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Birlie TA, Amare AT, Agegn SB, Yirga GK, Bantie B, Nega TD, Eshetie Y, Woelile TA, Asmare G, Belay AT, Tasew SF. Treatment seeking delay and associated factors in adult heart failure patients admitted to Debre Tabor comprehensive specialized hospital, North West, Ethiopia. Heliyon 2024; 10:e23348. [PMID: 38187228 PMCID: PMC10767366 DOI: 10.1016/j.heliyon.2023.e23348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 11/09/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Objectives This study was aimed at assessing the magnitude of treatment-seeking delay in adult heart failure patients and identifying factors that contribute to it. Design An institution-based cross-sectional study with a consecutive sampling technique was conducted at Debre Tabor Comprehensive Specialized Hospital from February 1 to November 1, 2021. Setting The study was conducted in the medical ward of the hospital. Participants A total of 187 patients aged 18 and above admitted with a diagnosis of heart failure, and able to provide information were included. Results The median delay time of adult heart failure patients admitted to the hospital was 15 days. The mean length of delay was also calculated to be 25.02 days. Urban residents and those who live at a ten or less-kilometer distance from healthcare facilities were found to be less likely to delay seeking care. Presenting with shortness of breath or paroxysmal nocturnal dyspnea, perceiving the cause to be heart-related, and getting positive responses from significant others were also associated with a relatively short delay time. Conclusion Treatment-seeking delay was found to be a major problematic issue in heart failure patients. Therefore, patients, patient families, and the community at large must be taught about the symptoms of heart failure and the need for timely care.
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Affiliation(s)
- Tekalign Amera Birlie
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Abraham Tsedalu Amare
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Setegn Bayabil Agegn
- Department of Statistics, Faculty of Natural and Computational Science, Debre Tabor University, Ethiopia
| | - Gebrie Kassaw Yirga
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Berihun Bantie
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Tadila Dires Nega
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Yeshambaw Eshetie
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Tamiru Alene Woelile
- Department of Pediatrics and Child Health Nursing, Injibara University, Ethiopia
| | - Getachew Asmare
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Ethiopia
| | - Alebachew Taye Belay
- Department of Statistics, Faculty of Natural and Computational Science, Debre Tabor University, Ethiopia
| | - Sheganew Fetene Tasew
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
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Makonokaya L, Kapanda L, Woelk GB, Chauma-Mwale A, Kalitera LU, Nkhoma H, Zimba S, Chamanga R, Golowa C, Machekano R, Maphosa T. Safety of Janssen Ad26.COV.S and Astra Zeneca AZD1222 COVID-19 Vaccines among Mobile Phone Users in Malawi: Findings from a National Mobile-Based Syndromic Surveillance Survey, July 2021 to December 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7123. [PMID: 38063553 PMCID: PMC10706488 DOI: 10.3390/ijerph20237123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/18/2023] [Accepted: 09/02/2023] [Indexed: 12/18/2023]
Abstract
The safety profiles of the Ad26.COV2.S and AZD1222 COVID-19 vaccines have not been described in the general population in Malawi. We present self-reported adverse events (AE) following the receipt of these vaccines in Malawi as part of a national syndromic surveillance survey. We conducted phone-based syndromic surveillance surveys among adults (≥18 years) with verbal consent. We used secure tablets through random digit dialing to select mobile phone numbers and collected data electronically. Survey questions included whether the respondent had received the COVID-19 vaccines, whether they had experienced any AE following vaccination, and the severity of the AE. We used multivariable analysis to identify factors associated with self-reported AE post-COVID-19 vaccination. A total of 11,924 (36.0%) out of 33,150 respondents reported receiving at least one dose of either Ad26.COV2.S or AZD1222 between July-December 2021; of those, 65.1% were female. About 49.2% of the vaccine recipients reported at least one AE, 90.6% of which were mild, and 2.6% were severe. Higher education level and concern about the safety of COVID-19 vaccines were associated with AE self-report (Adjusted Odds Ratio [AOR] 2.63 [95% CI 1.96-3.53] and 1.44, [95% CI 1.30-1.61], respectively), while male gender and older age were associated with reduced likelihood of AE self-report (AORs 0.81, [95% CI 0.75-0.88], 0.62 [95% CI 0.50-0.77], respectively). Ad26.COV2.S and AZD1222 vaccines are well-tolerated, with primarily mild and few severe AE among adults living in Malawi. Self-reporting of AE following COVID-19 vaccination is associated with gender, age, education, and concern about the safety of the vaccines. Recognizing these associations is key when designing and implementing COVID-19 vaccination communication messages to increase vaccination coverage.
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Affiliation(s)
- Lucky Makonokaya
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe P/Bag 2543, Malawi (R.C.); (C.G.); (T.M.)
| | - Lester Kapanda
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe P/Bag 2543, Malawi (R.C.); (C.G.); (T.M.)
| | - Godfrey B. Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC 20005, USA; (G.B.W.); (R.M.)
| | - Annie Chauma-Mwale
- Public Health Institute, Ministry of Health Malawi, Lilongwe P.O. Box 30377, Malawi
| | - Louiser Upile Kalitera
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe P/Bag 2543, Malawi (R.C.); (C.G.); (T.M.)
| | - Harrid Nkhoma
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe P/Bag 2543, Malawi (R.C.); (C.G.); (T.M.)
| | - Suzgo Zimba
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe P/Bag 2543, Malawi (R.C.); (C.G.); (T.M.)
| | - Rachel Chamanga
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe P/Bag 2543, Malawi (R.C.); (C.G.); (T.M.)
| | - Cathy Golowa
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe P/Bag 2543, Malawi (R.C.); (C.G.); (T.M.)
| | - Rhoderick Machekano
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC 20005, USA; (G.B.W.); (R.M.)
| | - Thulani Maphosa
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe P/Bag 2543, Malawi (R.C.); (C.G.); (T.M.)
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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: 2] [Impact Index Per Article: 2.0] [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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Nguyen HV, Brals D, Tiemersma E, Gasior R, Nguyen NV, Nguyen HB, Van Nguyen H, Le Thi NA, Cobelens F. Influence of Sex and Sex-Based Disparities on Prevalent Tuberculosis, Vietnam, 2017-2018. Emerg Infect Dis 2023; 29:967-976. [PMID: 37081548 PMCID: PMC10124636 DOI: 10.3201/eid2905.221476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
To assess sex disparities in tuberculosis in Vietnam, we conducted a nested, case-control study based on a 2017 tuberculosis prevalence survey. We defined the case group as all survey participants with laboratory-confirmed tuberculosis and the control group as a randomly selected group of participants with no tuberculosis. We used structural equation modeling to describe pathways from sex to tuberculosis according to an a priori conceptual framework. Our analysis included 1,319 participants, of whom 250 were case-patients. We found that sex was directly associated with tuberculosis prevalence (adjusted odds ratio for men compared with women 3.0 [95% CI 1.7-5.0]) and indirectly associated through other domains. The strong sex difference in tuberculosis prevalence is explained by a complex interplay of factors relating to behavioral and environmental risks, access to healthcare, and clinical manifestations. However, after controlling for all those factors, a direct sex effect remains that might be caused by biological factors.
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Total delay and associated factors among tuberculosis patients in Jimma Zone, Southwest Ethiopia. PLoS One 2023; 18:e0281546. [PMID: 36757943 PMCID: PMC10045582 DOI: 10.1371/journal.pone.0281546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Delays in diagnosis and treatment of tuberculosis (TB) increases severity of illness and continued transmission of TB in the community. Understanding the magnitude and factors associated with total delay is imperative to expedite case detection and treatment of TB. The aim of this study was to determine the length and analyze factors associated with total delay. METHODS Analytic cross-sectional study was conducted in Jimma Zone, Southwest Ethiopia. All newly diagnosed TB patients > 15 years of age were included from randomly selected eight districts and one town in the study area. A structured questionnaire was applied to collect socio-demographic and clinical data. The median total delay was used to dichotomize the sample into delayed and non-delayed patient categories. Logistic regression analysis was used to analyse the association between independent and outcome variables. A p-value < 0.05 were considered statistically significant. RESULTS A total of 1,161 patients were included in this study. The median total delay was 35 days. Patients who had swelling or wound in the neck region were more likely to be delayed than their counterpart [adjusted odds ratio (AOR) = 3.02, 95% confidence interval (CI): 1.62, 5.62]. Women were more likely to experience longer total delay (AOR = 1.46, 95% CI:1.00, 2.14) compared to men. Patients who had poor knowledge of TB were more likely to be delayed compared to those who had good knowledge (AOR = 3.92, 95% CI: 2.65, 5.80). CONCLUSION The present study showed long total delay in diagnosis and treatment of TB. Targeted interventions that enhance TB knowledge and practice, expedite early suspect identification, referral and management of all forms of TB is imperative to reduce total delay in diagnosis and treatment of TB.
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Zhang H, Liang C, Zhang X, Yu H, Yan X, Wang L, Tong T, Zhang H, Dai H, Tong H. Factors influencing patient delay in individuals with obstructive sleep apnoea: a study based on an integrated model. Ann Med 2022; 54:2828-2840. [PMID: 36259469 PMCID: PMC9586697 DOI: 10.1080/07853890.2022.2132417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder, yet it remains undiagnosed in a large proportion of adults. OBJECTIVE This study aims to investigate the status of patient delay and provider delay in OSA patients and examine related factors affecting patient delay in OSA individuals in China. METHODS A cross-sectional design was conducted on a sample of 309 OSA patients (aged from 18 to 76, median age of 47 years, 84.8% male) in Northeast China. Participants were required to complete the sociodemographic questionnaire, the symptom characteristics questionnaire, the help-seeking attitude scale (HSAS), the social support rating scale and the chronic disease self-efficacy scales (CDSES) to test the hypothesis. Binary logistic regression analysis was conducted to explore factors that account for the patient delay. RESULTS The median patient delay among OAS patients in this study was 22 months, the median provider delay was one month, and the median total delay was 26 months. As shown by multivariate analysis results, patients who have snored for over 6 years (OR = 3.377, 95%CI: 1.175-9.702) were more likely to experience prolonged patient delays. Per capita monthly family income above 3000 RMB (OR = 0.172, 95%CI: 0.052-0.571), taking up residence in cities or towns (OR = 0.484, 95%CI: 0.248-0.946), higher self-recognition of the disease (OR = 0.793, 95%CI: 0.647-0.972), higher objective support (OR = 0.825, 95%CI: 0.739-0.921) and stronger self-efficacy (OR = 0.674, 95%CI: 0.525-0.867) were significantly associated with shorter patient delays. CONCLUSION Patient delay is common in Chinese OSA patients. The upstream factors affecting the patient delay in individuals with OSA include income, place of residence, and objective support; midstream factors include self-recognition of the disease and self-efficacy; downstream factors include years of snoring.KEY MESSAGESDespite being a high-prevalence disease, many obstructive sleep apnoea (OSA) patients are not clearly diagnosed and treated.The factors affecting the delay in seeking medical treatment in individuals with OSA included income, place of residence, objective support, self-recognition of the disease, self-efficacy and years of snoring.Investigations into OSA patients' care-seeking behaviours can better reflect the secondary prevention of OSA, and it is crucial to pay attention to the delayed phase of patients.
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Affiliation(s)
- Hui Zhang
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Chunguang Liang
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Xin Zhang
- Department of Respiratory Medicine, Zibo Central Hospital, Zibo, PR China
| | - Haitao Yu
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Xiangru Yan
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Liying Wang
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Tong Tong
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Huiying Zhang
- Department of Otolaryngology Head & Neck Surgery, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China
| | - Hongliang Dai
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Huijuan Tong
- Department of Nursing, Shenyang Medical College, Shenyang, PR China
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Knowledge of symptoms and delays in diagnosis of extrapulmonary tuberculosis patients in North Shewa zone, Ethiopia. PLoS One 2022; 17:e0270002. [PMID: 35709224 PMCID: PMC9202887 DOI: 10.1371/journal.pone.0270002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/01/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Delayed diagnosis contributes to the high burden and transmission of tuberculosis and extrapulmonary tuberculosis (EPTB) and continued to be a major public health problem in Ethiopia. Currently, there is insufficient knowledge on the contributing factors to diagnostic delay of EPTB patients in healthcare settings in Ethiopia, because of unique cultural and societal issues in this country. This study assessed patients’ knowledge of symptoms and contributing factors of delay in diagnosis of EPTB patients at selected public health facilities in North Shewa zone, Ethiopia.
Methods
An institutional-based study was conducted from March to April 2021. All recently registered EPTB patients were included. Logistic regression was performed to analyze the data. A significant association was declared at a p-value of < 0.05, and the results were presented with an adjusted odds ratio (AOR) and the corresponding 95% confidence interval (CI).
Results
In this study, only 15.5% of respondents knew EPTB symptoms. The median patient and healthcare system delay was 55 days. A patient delay of greater than 3 weeks and a health system delay of greater than 2 weeks were observed among 85.2% and 81% of patients, respectively. After the end of 5 weeks, 87.3% of EPTB patients had been diagnosed with the disease and the total median delay was 108.5 days. Living more than ten kilometers far from a health facility (AOR = 1.54; 95% CI = 1.11, 4.63), having never heard of EPTB disease (AOR = 5.52; 95% CI = 1.73, 17.56), and having ever taken antibiotics at the first health facility visit (AOR = 7.62; 95% CI = 2.26, 25.65) were associated with a total diagnostic delay of beyond 5 weeks.
Conclusions
The diagnostic delays of EPTB remain high. Both patient and health system delays equally contributed to the total diagnosis delay. Improving community awareness of EPTB and advancing diagnostic efficiencies of healthcare facilities could help reduce both delays.
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Wang Y, Feng J, Zhang J, Shen X, Lei Z, Zhu Y, Meng X, Di H, Xia W, Lu Z, Guo Y, Yuan Q, Wang X, Gan Y. Willingness to seek medical care for tuberculosis and associated factors among the elderly population in Shenzhen: a cross-sectional study. BMJ Open 2021; 11:e051291. [PMID: 34548361 PMCID: PMC8458307 DOI: 10.1136/bmjopen-2021-051291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study was aimed to assess the willingness of elderly people to seek medical care for tuberculosis (TB) and the associated influencing factors. DESIGN A cross-sectional study. SETTING A multistage random survey was conducted in Bao'an District of Shenzhen in China. PARTICIPANTS A total of 1200 elderly people aged 65 or above were recruited for the study and completed a structured questionnaire between September and October 2019. MAIN OUTCOME MEASURES Descriptive and binary logistic stepwise regression analyses were conducted to analyse the characteristics of elderly individuals, their willingness to seek medical care for TB and associated factors. RESULTS Among the final 1123 respondents, 943 (84.0%) were willing to seek medical care if they discovered suspicious TB symptoms. Binary logistic stepwise regression analysis indicated that respondents whose family annual income per capita was 50 000-100 000¥ (OR=2.56, 95% CI: 1.44 to 4.54, p<0.01) and who had positive attitudes (≥3 scores: OR=3.10, 95% CI: 1.90 to 5.05, p<0.01) or practices (≥4 scores: OR=3.13, 95% CI: 1.82 to 5.39, p<0.01) towards TB were more willing to seek medical care for TB. CONCLUSIONS Willingness to seek medical care for TB in the elderly population can be improved according to the determinants.
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Affiliation(s)
- Yunxia Wang
- Dapartment of Tuberculosis Prevention and Control, Shenzhen Bao'an Centre for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Jing Feng
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Juanjuan Zhang
- Dapartment of Tuberculosis Prevention and Control, Shenzhen Bao'an Centre for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Xin Shen
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Zihui Lei
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Yi Zhu
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Xin Meng
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Hongkun Di
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Wenqi Xia
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Yanfang Guo
- Dapartment of Tuberculosis Prevention and Control, Shenzhen Bao'an Centre for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Qing Yuan
- Dapartment of Tuberculosis Prevention and Control, Shenzhen Bao'an Centre for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Xiaojun Wang
- Office of Tuberculosis Control and Management, Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Yong Gan
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
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