Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam, Tanzania.

Said, Khadija; Hella, Jerry; Mhalu, Grace; Chiryankubi, Mary; Masika, Edward; Maroa, Thomas; Mhimbira, Francis; Kapalata, Neema; Fenner, Lukas (2017). Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam, Tanzania. Infectious diseases of poverty, 6(1), p. 64. BioMed Central 10.1186/s40249-017-0276-4

[img]
Preview
Text
Said InfectDisPoverty 2017.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (967kB) | Preview

BACKGROUND

Tanzania is among the 30 countries with the highest tuberculosis (TB) burdens. Because TB has a long infectious period, early diagnosis is not only important for reducing transmission, but also for improving treatment outcomes. We assessed diagnostic delay and associated factors among infectious TB patients.

METHODS

We interviewed new smear-positive adult pulmonary TB patients enrolled in an ongoing TB cohort study in Dar es Salaam, Tanzania, between November 2013 and June 2015. TB patients were interviewed to collect information on socio-demographics, socio-economic status, health-seeking behaviour, and residential geocodes. We categorized diagnostic delay into ≤ 3 or > 3 weeks. We used logistic regression models to identify risk factors for diagnostic delay, presented as crude (OR) and adjusted Odds Ratios (aOR). We also assessed association between geographical distance (incremental increase of 500 meters between household and the nearest pharmacy) with binary outcomes.

RESULTS

We analysed 513 patients with a median age of 34 years (interquartile range 27-41); 353 (69%) were men. Overall, 444 (87%) reported seeking care from health care providers prior to TB diagnosis, of whom 211 (48%) sought care > 2 times. Only six (1%) visited traditional healers before TB diagnosis. Diagnostic delay was positively associated with absence of chest pain (aOR = 7.97, 95% confidence intervals [CI]: 3.15-20.19; P < 0.001), and presence of hemoptysis (aOR = 25.37, 95% CI: 11.15-57.74; P < 0.001) and negatively associated with use of medication prior to TB diagnosis (aOR = 0.31, 95% CI: 0.14-0.71; P = 0.01). Age, sex, HIV status, education level, household income, and visiting health care facilities (HCFs) were not associated with diagnostic delay. Patients living far from pharmacies were less likely to visit a HCF (incremental increase of distance versus visit to any facility: OR = 0.51, 95% CI: 0.28-0.96; P = 0.037).

CONCLUSIONS

TB diagnostic delay was common in Dar es Salaam, and was more likely among patients without prior use of medication and presenting with hemoptysis. Geographical distance to HCFs may have an impact on health-seeking behaviour. Increasing community awareness of TB signs and symptoms could further reduce diagnostic delays and interrupt TB transmission.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Fenner, Lukas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2049-9957

Publisher:

BioMed Central

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

27 Feb 2018 14:21

Last Modified:

05 Dec 2022 15:10

Publisher DOI:

10.1186/s40249-017-0276-4

PubMed ID:

28335816

Uncontrolled Keywords:

Diagnostic delay Geographic information system Health-seeking Pharmacy Tanzania Transmission Tuberculosis

BORIS DOI:

10.7892/boris.111765

URI:

https://boris.unibe.ch/id/eprint/111765

Actions (login required)

Edit item Edit item
Provide Feedback