PMID- 27836012
OWN - NLM
STAT- MEDLINE
DCOM- 20170515
LR  - 20181202
IS  - 1471-2334 (Electronic)
IS  - 1471-2334 (Linking)
VI  - 16
IP  - 1
DP  - 2016 Nov 11
TI  - 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.
PG  - 673
LID - 673
AB  - 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.
FAU - Gebreegziabher, Senedu Bekele
AU  - Gebreegziabher SB
AD  - Amhara Regional State Health Bureau, Bahir Dar, Ethiopia. 
      sinidu_bekele@yahoo.com.
AD  - Department of Community Medicine, Institute of Health and Society, University of 
      Oslo, Oslo, Norway. sinidu_bekele@yahoo.com.
FAU - Bjune, Gunnar Aksel
AU  - Bjune GA
AD  - Department of Community Medicine, Institute of Health and Society, University of 
      Oslo, Oslo, Norway.
FAU - Yimer, Solomon Abebe
AU  - Yimer SA
AD  - Amhara Regional State Health Bureau, Bahir Dar, Ethiopia.
AD  - Department of Community Medicine, Institute of Health and Society, University of 
      Oslo, Oslo, Norway.
AD  - Oslo University Hospital, Oslo, Norway.
AD  - Department of Bacteriology and Immunology, Division of Infectious Disease 
      Control, Norwegian Institute of Public Health, Oslo, Norway.
LA  - eng
PT  - Journal Article
DEP - 20161111
PL  - England
TA  - BMC Infect Dis
JT  - BMC infectious diseases
JID - 100968551
RN  - 0 (Antitubercular Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Antitubercular Agents/administration & dosage/therapeutic use
MH  - Cross-Sectional Studies
MH  - Delayed Diagnosis
MH  - Ethiopia/epidemiology
MH  - Female
MH  - Government Programs
MH  - *Health Services Accessibility
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Time Factors
MH  - Tuberculosis, Pulmonary/*diagnosis/drug therapy/epidemiology
PMC - PMC5106835
OTO - NOTNLM
OT  - Ethiopia
OT  - Health system's delay
OT  - Patients' delay
OT  - Tuberculosis
OT  - West Gojjam Zone
OT  - diagnostic delay
EDAT- 2016/11/12 06:00
MHDA- 2017/05/16 06:00
PMCR- 2016/11/11
CRDT- 2016/11/13 06:00
PHST- 2016/05/03 00:00 [received]
PHST- 2016/10/29 00:00 [accepted]
PHST- 2016/11/13 06:00 [entrez]
PHST- 2016/11/12 06:00 [pubmed]
PHST- 2017/05/16 06:00 [medline]
PHST- 2016/11/11 00:00 [pmc-release]
AID - 10.1186/s12879-016-1995-z [pii]
AID - 1995 [pii]
AID - 10.1186/s12879-016-1995-z [doi]
PST - epublish
SO  - BMC Infect Dis. 2016 Nov 11;16(1):673. doi: 10.1186/s12879-016-1995-z.