Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study

Abstract Background Tuberculosis (TB) is a major public health concern in the developing world. Early diagnosis and prompt initiation of treatment is essential for effective TB control. The aim of this study was to determine the length and analyze associated factors of patients’ and health system’s delays in the diagnosis and treatment of new pulmonary TB (PTB) patients. Methods A cross-sectional study was conducted in 30 randomly selected public health facilities in West Gojjam Zone, Amhara Region, Ethiopia. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study. Patients’ delay (the time period from onset of TB symptoms to first presentation to a formal health provider) and health system’s delay (the time period from first presentation to a formal health provider to first start of TB treatment) were measured. Median patients’ and health system’s delays were calculated. Mixed effect logistic regression was used to analyze predictors of patients’ and health system’s delays. Results Seven hundred six patients were enrolled in the study. The median patients’ delay was 18 days (interquartile range [IQR]: 8–34 days) and the median health system’s delay was 22 days (IQR: 4–88 days). Poor knowledge of TB (adjusted odds ratio [AOR], 2.33; 95 % confidence interval [CI], 1.34–4.05), first visit to non-formal health provider (AOR, 47.56; 95 % CI, 26.31–85.99), self-treatment (AOR, 10.11; 95 % CI, 4.53–22.56) and patients’ age (≥45 years) (AOR, 2.99; 95 % CI, 1.14–7.81) were independent predictors of patients’ delay. Smear-negative TB (AOR, 1.88; 95 % CI, 1.32–2.68) and first visit to public health centers (AOR, 2.22; 95 % CI, 1.52–3.25) and health posts (AOR, 5.86; 95 % CI, 1.40–24.39) were found to be independent predictors of health system’s delay. Conclusions The health system’s delay in this study was long and contributed more than 50 % of the total delay. Better TB diagnostic tools to complement sputum smear microscopy are needed to early diagnose PTB cases at peripheral health facilities. In addition, due emphasis should be given to increase public awareness about symptoms and consequences of TB disease

Qualitative Assessment of Challenges in Tuberculosis Control in West Gojjam Zone, Northwest Ethiopia: Health Workers’ and Tuberculosis Control Program Coordinators’ Perspectives

Background Weak health systems pose many barriers to effective tuberculosis (TB) control. This study aimed at exploring health worker’s and TB control program coordinator’s perspectives on health systems challenges facing TB control in West Gojjam Zone, Amhara Region, Ethiopia. Methods This was a qualitative descriptive study. Eight in-depth interviews with TB control program coordinators and two focus group discussions among 16 health workers were conducted. Purposive sampling was used to recruit study participants. Thematic analysis was used to identify and analyse main themes. Results We found that intermittent interruptions of laboratory reagents and anti-TB drugs supplies, absence of trained and motivated health workers, poor TB data documentation, lack of adherence to TB treatment guideline, and lack of access to TB diagnostic tools at peripheral health institutions were challenges facing the TB control program performance in the study zone. Conclusions Ensuring uninterrupted supply of anti-TB drugs and laboratory reagents to all health institutions is essential. Continuous refresher training of health workers on standard TB care and data handling and developing and implementing a sound retention strategy to attract and motivate health professionals to work in rural areas are necessary interventions to improve the TB control program performance in the study zone

Total delay is associated with unfavorable treatment outcome among pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: A prospective cohort study

Background delay in diagnosis and treatment of tuberculosis (TB) may worsen the disease, increase mortality and enhance transmission in the community. This study aimed at assessing the association between total delay and unfavorable treatment outcome among newly diagnosed pulmonary TB (PTB) patients. Methods A prospective cohort study was conducted in West Gojjam Zone, Amhara Region of Ethiopia from October 2013 to May 2015. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study from 30 randomly selected public health facilities. Total delay (the time period from onset of TB symptoms to first start of anti-TB treatment) was measured. Median total delay was calculated. Mixed effect logistics regression was used to analyze factors associated with unfavorable treatment outcome. Results Seven hundred six patients were enrolled in the study. The median total delay was 60 days. Patients with total delay of > 60 days were more likely to have unfavorable TB treatment outcome than patients with total delay of ≤ 60 days (adjusted odds ratio [AOR], 2.33; 95% confidence interval [CI], 1.04–5.26). Human immunodeficiency virus (HIV) positive TB patients were 8.46 times more likely to experience unfavorable treatment outcome than HIV negative TB patients (AOR, 8.46; 95% CI, 3.14–22.79). Conclusions Long total delay and TB/HIV coinfection were associated with unfavorable treatment outcome. Targeted interventions that can reduce delay in diagnosis and treatment of TB, and early comprehensive management of TB/HIV coinfection are needed to reduce increased risk of unfavorable treatment outcome

Knowledge about TB and health seeking of the study participants, October 2013 to May 2015, West Gojjam Zone, Ethiopia.

<p>Knowledge about TB and health seeking of the study participants, October 2013 to May 2015, West Gojjam Zone, Ethiopia.</p

Associations of socio-demographic and clinical factors with unfavorable treatment outcome of new PTB patients, October 2013 to May 2015, West Gojjam Zone, Ethiopia.

<p>Associations of socio-demographic and clinical factors with unfavorable treatment outcome of new PTB patients, October 2013 to May 2015, West Gojjam Zone, Ethiopia.</p

Baseline signs and symptoms of new PTB patients stratified by median total delay, October 2013 to May 2015, West Gojjam Zone, Ethiopia.

<p>Baseline signs and symptoms of new PTB patients stratified by median total delay, October 2013 to May 2015, West Gojjam Zone, Ethiopia.</p

Kaplan-Meier estimate survival curves showing unfavorable treatment outcome of new PTB patients by total delay status.

<p>Kaplan-Meier estimate survival curves showing unfavorable treatment outcome of new PTB patients by total delay status.</p

Associations of socio-demographic and clinical factors with total delay of new PTB patients, October 2013 to May 2015, West Gojjam Zone, Ethiopia.

<p>Associations of socio-demographic and clinical factors with total delay of new PTB patients, October 2013 to May 2015, West Gojjam Zone, Ethiopia.</p

Factors associated with death of PTB patients, October 2013 to May 2015, West Gojjam Zone, Ethiopia.

<p>Factors associated with death of PTB patients, October 2013 to May 2015, West Gojjam Zone, Ethiopia.</p

Study participants profile.

<p>Study participants profile.</p