Empirical evidence of delays in diagnosis and treatment of pulmonary tuberculosis: systematic review and meta-regression analysis

BMC Public Health

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[1] 0000 0004 1794 5983, grid.9582.6, Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria;Cochrane, Editorial and Methods Department, Cochrane Central Executive, Cochrane Informatics and Knowledge Management Department Denmark ApS, c/o Rigshospitalet, afd. 7811, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark;

关键词: Pulmonary tuberculosis;    Evidence;    Meta-regression model;    Delay;    Patient;    Doctor;    Treatment;    Health system;    Total;    Disease control;   

DOI  :  10.1186/s12889-019-7026-4

来源: publisher

【 摘 要 】

BackgroundDelays in diagnosis and treatment of pulmonary tuberculosis are a major set-back to global tuberculosis control. There is currently no global evidence on the average delays thus, the most important contributor to total delay is unknown. We aimed to estimate average delay measures and to investigate sources for heterogeneity among studies assessing delay measures.MethodsSystematic review of studies reporting mean (± standard deviation) or median (interquartile range, IQR) of patient, doctor, diagnostic, treatment, health system and/or total delays in journal articles indexed in PubMed. We pooled mean delays using random-effects inverse variance meta-analysis, investigated for variations in pooled estimates in subgroup analyses and explored for sources of heterogeneity using pre-specified explanatory variables.ResultsThe systematic review included 198 studies (831,724 patients) from 78 countries. The median number of patients per study was 243 (IQR; 160–458) patients.Overall, the pooled mean total delay was 87.6 (95% CI: 81.4–93.9) days. The most important and largest contributor to total delay was patient delay with a pooled mean delay of 81 (95% CI: 70–92) days followed by doctor’s delay and treatment delay with pooled mean delays of 29.5 (95% CI: 25.9–33.0) and 7.9 (95% CI: 6.9–8.9) days respectively. There was considerable heterogeneity in all pooled analyses (I2 > 95%). In the meta-regression models of mean delays, studies excluding extra-pulmonary tuberculosis patients reported increased mean doctor’s delay by 45 days on average, non-use of chest x-ray and conducting studies in high income countries decreased mean treatment delay by 20 and 22 days on average, respectively.ConclusionStrategies to address patients’ delay could have important implications for the success of the global tuberculosis control programmes.

【 授权许可】

CC BY