Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study
<p>Abstract</p> <p>Background</p> <p>Nigeria ranks fourth among 22 high tuberculosis (TB) burden countries. Although it reached 99% DOTS coverage in 2008, current case detection rate is 40%. Little is known about delays before the start of TB therapy and health-seeking...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2013-01-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://www.biomedcentral.com/1472-6963/13/25 |
| _version_ | 1819036814525071360 |
|---|---|
| author | Ukwaja Kingsley N Alobu Isaac Nweke Chibueze O Onyenwe Ephraim C |
| author_facet | Ukwaja Kingsley N Alobu Isaac Nweke Chibueze O Onyenwe Ephraim C |
| author_sort | Ukwaja Kingsley N |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Nigeria ranks fourth among 22 high tuberculosis (TB) burden countries. Although it reached 99% DOTS coverage in 2008, current case detection rate is 40%. Little is known about delays before the start of TB therapy and health-seeking behaviour of TB patients in rural resource-limited settings. We aimed to: 1) assess healthcare-seeking behaviour and delay in treatment of pulmonary TB patients, 2) identify the determinants of the delay in treatment of pulmonary TB.</p> <p>Methods</p> <p>We conducted a cross-sectional study of adult new pulmonary TB patients notified to the National Tuberculosis Control Programme (NTP) by three rural (two mission/one public) hospitals. Data on health-seeking and delays were collected using a standardised questionnaire. We defined patient delay as the interval (weeks) between the onset of cough and the first visit to any health provider, and health system delay as the time interval (weeks) between patient's first attendance to any health provider, and the onset of treatment. Total delay is the sum of both delays. Multiple linear regression models using nine exposure variables were built to identify determinants of delays.</p> <p>Results</p> <p>Of 450 patients (median age 30 years) enrolled, most were males (55%), subsistent farmers (49%), rural residents (78%); and 39% had no formal education. About 84% of patients reported first consulting a non-NTP provider. For such patients, the first facilities visited after onset of symptoms were drug shops (79%), traditional healers (10%), and private hospitals (10%). The median total delay was 11 (IQR 9–16) weeks, patient delay 8 (IQR 8–12) and health system (HS) delay 3 (IQR 1–4) weeks. Factors associated with increased patient delay were older age (P <0.001) longer walking distance to a public facility (<0.001), and urban residence (P <0.001). Male gender (P = 0.001) and an initial visit to a non-NTP provider (P = 0.025) were independent determinants of prolonged HS delay. Those associated with longer total delay were older age (P <0.001), male gender (P = 0.045), and urban residence (P<0.001).</p> <p>Conclusion</p> <p>Overall, TB treatment delays were high; and needs to be reduced in Nigeria. This may be achieved through improved access to care, further education of patients, engagement of informal care providers, and strengthening of existing public-private partnerships in TB control.</p> |
| first_indexed | 2024-12-21T08:11:30Z |
| format | Article |
| id | doaj.art-8e881e0348cb491b9478f36779560746 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-21T08:11:30Z |
| publishDate | 2013-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-8e881e0348cb491b9478f367795607462022-12-21T19:10:39ZengBMCBMC Health Services Research1472-69632013-01-011312510.1186/1472-6963-13-25Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional studyUkwaja Kingsley NAlobu IsaacNweke Chibueze OOnyenwe Ephraim C<p>Abstract</p> <p>Background</p> <p>Nigeria ranks fourth among 22 high tuberculosis (TB) burden countries. Although it reached 99% DOTS coverage in 2008, current case detection rate is 40%. Little is known about delays before the start of TB therapy and health-seeking behaviour of TB patients in rural resource-limited settings. We aimed to: 1) assess healthcare-seeking behaviour and delay in treatment of pulmonary TB patients, 2) identify the determinants of the delay in treatment of pulmonary TB.</p> <p>Methods</p> <p>We conducted a cross-sectional study of adult new pulmonary TB patients notified to the National Tuberculosis Control Programme (NTP) by three rural (two mission/one public) hospitals. Data on health-seeking and delays were collected using a standardised questionnaire. We defined patient delay as the interval (weeks) between the onset of cough and the first visit to any health provider, and health system delay as the time interval (weeks) between patient's first attendance to any health provider, and the onset of treatment. Total delay is the sum of both delays. Multiple linear regression models using nine exposure variables were built to identify determinants of delays.</p> <p>Results</p> <p>Of 450 patients (median age 30 years) enrolled, most were males (55%), subsistent farmers (49%), rural residents (78%); and 39% had no formal education. About 84% of patients reported first consulting a non-NTP provider. For such patients, the first facilities visited after onset of symptoms were drug shops (79%), traditional healers (10%), and private hospitals (10%). The median total delay was 11 (IQR 9–16) weeks, patient delay 8 (IQR 8–12) and health system (HS) delay 3 (IQR 1–4) weeks. Factors associated with increased patient delay were older age (P <0.001) longer walking distance to a public facility (<0.001), and urban residence (P <0.001). Male gender (P = 0.001) and an initial visit to a non-NTP provider (P = 0.025) were independent determinants of prolonged HS delay. Those associated with longer total delay were older age (P <0.001), male gender (P = 0.045), and urban residence (P<0.001).</p> <p>Conclusion</p> <p>Overall, TB treatment delays were high; and needs to be reduced in Nigeria. This may be achieved through improved access to care, further education of patients, engagement of informal care providers, and strengthening of existing public-private partnerships in TB control.</p>http://www.biomedcentral.com/1472-6963/13/25TuberculosisHealth-seeking delaysPrivate sectorPublic sectorRuralLow-resource setting |
| spellingShingle | Ukwaja Kingsley N Alobu Isaac Nweke Chibueze O Onyenwe Ephraim C Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study BMC Health Services Research Tuberculosis Health-seeking delays Private sector Public sector Rural Low-resource setting |
| title | Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study |
| title_full | Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study |
| title_fullStr | Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study |
| title_full_unstemmed | Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study |
| title_short | Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study |
| title_sort | healthcare seeking behavior treatment delays and its determinants among pulmonary tuberculosis patients in rural nigeria a cross sectional study |
| topic | Tuberculosis Health-seeking delays Private sector Public sector Rural Low-resource setting |
| url | http://www.biomedcentral.com/1472-6963/13/25 |
| work_keys_str_mv | AT ukwajakingsleyn healthcareseekingbehaviortreatmentdelaysanditsdeterminantsamongpulmonarytuberculosispatientsinruralnigeriaacrosssectionalstudy AT alobuisaac healthcareseekingbehaviortreatmentdelaysanditsdeterminantsamongpulmonarytuberculosispatientsinruralnigeriaacrosssectionalstudy AT nwekechibuezeo healthcareseekingbehaviortreatmentdelaysanditsdeterminantsamongpulmonarytuberculosispatientsinruralnigeriaacrosssectionalstudy AT onyenweephraimc healthcareseekingbehaviortreatmentdelaysanditsdeterminantsamongpulmonarytuberculosispatientsinruralnigeriaacrosssectionalstudy |