Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study
Abstract Background Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of se...
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-020-08967-0 |
| _version_ | 1818478371433086976 |
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| author | Daniel G. Datiko Degu Jerene Pedro Suarez |
| author_facet | Daniel G. Datiko Degu Jerene Pedro Suarez |
| author_sort | Daniel G. Datiko |
| collection | DOAJ |
| description | Abstract Background Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia. Methods This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay. Results Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10–45), 4 (2–10) and 2 (1–3) days respectively. The median (IQR) of total delay was 33 (19–67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. Poverty, cost of seeking care, protracted diagnostic and treatment initiation, inadequate community based TB care and lack of awareness were associated with delay. Community health workers reported that lack of awareness and the expectation that symptoms would resolve by themselves were the main reasons for delay. Conclusion TB patients’ delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia. |
| first_indexed | 2024-12-10T09:47:14Z |
| format | Article |
| id | doaj.art-1e029882928e459e961eee61fa5d64e1 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-10T09:47:14Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-1e029882928e459e961eee61fa5d64e12022-12-22T01:53:47ZengBMCBMC Public Health1471-24582020-07-0120111010.1186/s12889-020-08967-0Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional studyDaniel G. Datiko0Degu Jerene1Pedro Suarez2Challenge TB Ethiopia /Management Sciences for Health EthiopiaChallenge TB Ethiopia /Management Sciences for Health EthiopiaManagement Sciences for Health, Senior Director Infectious Disease ClusterAbstract Background Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia. Methods This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay. Results Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10–45), 4 (2–10) and 2 (1–3) days respectively. The median (IQR) of total delay was 33 (19–67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. Poverty, cost of seeking care, protracted diagnostic and treatment initiation, inadequate community based TB care and lack of awareness were associated with delay. Community health workers reported that lack of awareness and the expectation that symptoms would resolve by themselves were the main reasons for delay. Conclusion TB patients’ delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia.http://link.springer.com/article/10.1186/s12889-020-08967-0TuberculosisPatient delayHealth system delayEthiopia |
| spellingShingle | Daniel G. Datiko Degu Jerene Pedro Suarez Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study BMC Public Health Tuberculosis Patient delay Health system delay Ethiopia |
| title | Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study |
| title_full | Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study |
| title_fullStr | Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study |
| title_full_unstemmed | Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study |
| title_short | Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study |
| title_sort | patient and health system delay among tb patients in ethiopia nationwide mixed method cross sectional study |
| topic | Tuberculosis Patient delay Health system delay Ethiopia |
| url | http://link.springer.com/article/10.1186/s12889-020-08967-0 |
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