Patient and health system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi

BMC Infectious Diseases

Peter W Chang¹  Shoei-Loong Lin⁵  Chen-Yuan Chiang⁴  Mei-ling Sheu²  Lumbani Makwakwa³ 

[1] College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan;School of Health Care Administration, Taipei Medical University, Taipei City, Taiwan;Pharmaceutical Services Section, Christian Health Association of Malawi (CHAM), Lilongwe, Malawi;Department of Internal Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan

关键词: Case detection;    Tuberculosis;    Health system delay;    Patient delay;   

Others  :  1134382
DOI  :  10.1186/1471-2334-14-132

 received in 2013-06-11, accepted in 2014-02-19,  发布年份 2014

【 摘 要 】

Background

Tuberculosis (TB) control remains a challenge in Malawi despite the National TB Control Program since 1984. This study aimed at measuring patient and health system delays and identifying factors associated with these delays.

Methods

A cross-sectional survey of 588 pulmonary TB patients was conducted in three TB centres in Blantyre, Lilongwe, and Mzuzu, between July and December 2011 using a semi-structured questionnaire. Patient delay was defined as the time interval between the onset of TB symptom(s) (a common symptom being coughing) to the first visit to any health provider. Health system delay was the interval from the first care-seeking visit at any health provider to the initiation of anti-tuberculosis treatment. Participants were invited to participate in the study during intensive phase of treatment. The characteristics associated with patient and health system delays were analyzed.

Results

The median patient delay was 14 days for both new and retreatment TB cases (interquartile range [IQR] 14 – 28 and 7 – 21, respectively). The median health system delay was 59 days (IQR 26 – 108) for new and 40.5 days (IQR 21–90) for retreatment cases. Factors associated with longer patient delay in new cases included primary education (adjusted odds ratio [AOR] 2.2, 95% CI 1.3 – 3.9) and knowledge that more than three weeks of coughing is a sign of TB (AOR 1.9, 1.1 – 3.3). In retreatment cases, distance >10 Km (AOR 3.3, 1.1 – 9.6) and knowledge that more than three weeks of coughing is a sign of TB (AOR 3.7, 1.3 – 10.7; p < 0.05) were significant factors. Making the first visit to a health centre (OR 1.9, 0.9 – 3.8) or a drug store/ traditional healer (OR 5.1, 1.1 – 21.7) in new TB cases were associated with a longer health system delay (p < 0.05) while smear negative (OR 6.4, 1.5 – 28.3), and smear unknown or not done (OR 6.1, 1.3 – 26.9) among retreatment cases were associated with a longer health system delay (p < 0.05).

Conclusions

Effective management and new diagnostic techniques are needed especially among retreatment cases. It is also needed to address geographic barriers to accessing care and increasing TB awareness in the community.

【 授权许可】

   
2014 Makwakwa et al.; licensee BioMed Central Ltd.

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