Delay in diagnosis of pulmonary tuberculosis in low-and middle-income settings: systematic review and meta-analysis

BMC Pulmonary Medicine

Research Article

Meaza Demissie¹  Fentabil Getnet²  Alemayehu Worku³  Nega Assefa⁴  Bizatu Mengistie⁴ 

[1] Addis Continental Institute of Public Health, Addis Ababa, Ethiopia;Department of Public Health, College of Medicine and Health Sciences, Jigjiga University, PO Box = 1020, Jigjiga, Ethiopia;School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia;

关键词: Patient delay;    Health system;    Diagnosis delay;    Pulmonary tuberculosis;   

DOI  :  10.1186/s12890-017-0551-y

 received in 2017-08-10, accepted in 2017-11-30,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAssessment of delays in seeking care and diagnosis of tuberculosis is essential to evaluate effectiveness of tuberculosis control programs, and identify programmatic impediments. Thus, this review of studies aimed to examine the extent of patient, health system, and total delays in diagnosis of pulmonary tuberculosis in low- and middle- income countries.MethodsIt was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic databases were searched to retrieve studies published from 2007 to 2015 including Pubmed central, Springer link, Hinari and Google scholar. Searching terms were pulmonary tuberculosis, health care seeking, health care seeking behavior, patient delay, diagnostic delay, health system delay, provider delay, and doctor delay. Retrieved studies were systematically reviewed and summarized using Comprehensive Meta-analysis software.ResultsForty studies involving 18,975 patients qualified for systematic review, and 14 of them qualified for meta-analysis. The median diagnostic delay ranged from 30 to 366.5 days [IQR = 44–77.8], with a 4–199 days [IQR = 15–50] and 2–128.5 days [IQR = 12–34] due to patient and health system delays, respectively. The meta-analysis showed 42% of pulmonary tuberculosis patients delayed seeking care by a month or more; uneducated patients [pooled OR = 1.5, 95%CI = 1.1–1.9] and those who sought initial care from informal providers [pooled OR = 3, 95%CI = 2.3–3.9] had higher odds of patient delay.ConclusionDelay in diagnosis is still a major challenge of tuberculosis control and prevention programs in low- and middle- income settings. Efforts to develop new strategies for better case-finding using the existing systems and improving patients’ care seeking behavior need to be intensified.

【 授权许可】

CC BY   
© The Author(s). 2017