Delays in care seeking treatment among persons with new pulmonary tuberculosis in Mandalay District, Central Myanmar
Main Article Content
Abstract
Tuberculosis (TB) is a major public health problem, and Myanmar is one of the 20 TB high-burden countries worldwide. Delay in getting TB diagnosis and treatment will lead to a disastrous impact on the community. This study aims to assess the delays in treatment-seeking and associated factors among new pulmonary TB patients in Mandalay District, central Myanmar. A cross-sectional study was conducted in 13 TB at outpatient department (OPD) public health facility sites. Data were collected by face-to-face interviews and treatment-card reviews of new adult patients who registered and started treatment with the standard regimen from December 2015 to May 2016. Delay time was categorised by using median cut-off. Multiple logistic regression analysis was performed to assess the relative impact of predictor variables on delays in seeking treatment. The analysis revealed that being aged 35 years or older (AOR 1.85, 95% CI 1.05–3.28) and low level of knowledge (AOR 2.29, 95% CI 1.29–4.08) contributed to a delay in seeking diagnosis and treatment, while the total medical and transportation cost (AOR 0.45, 95% CI 0.25–0.81) and no symptomatic (AOR 0.43, 95% CI 0.21–0.90) could increase the delay. Strengthening the health education activities for the community about TB and capacity building of health care providers to increase suspicion for identifying TB and early diagnosis are crucial.
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References
World Health Organization. Global tuberculosis report 2019. Geneva: World Health Organization; 2019.
National Tuberculosis Program. Annual report 2015. Myanmar: Natioanl Tuberculosis Program; 2015.
Bello S, Afolabi RF, Ajayi DT, Sharma T, Owoeye DO, Oduyoye O, et al. Empirical evidence of delays in diagnosis and treatment of pulmonary tuberculosis: Systematic review and meta-regression analysis. BMC Public Health. 2019;19(1).
Yang Q, Tong Y, Yin X, Qiu L, Sun N, Zhao Y, et al. Delays in care seeking, diagnosis and treatment of patients with pulmonary tuberculosis in Hubei, China. International health. 2020;12(2):101-6.
Alipour N, Sheikhi M, Charati JY, Mohsenipouya H, Shabankhani B, Rezaii MS. Total delay and associated factors in pulmonary tuberculosis patients in Golestan province. Caspian Journal of Internal Medicine. 2020;11(1):67-74.
Wondawek TM, Ali MM. Delay in treatment seeking and associated factors among suspected pulmonary tuberculosis patients in public health facilities of Adama town, eastern Ethiopia. BMC Public Health. 2019;19(1).
Wang X, Fu Q, Zhang Z, Lu Z, Han D, Nan J, et al. Delay on care-seeking and related influencing factors among tuberculosis patients in Wuhan, 2008-2017. Chinese Journal of Endemiology. 2019;40(6):643-7.
Ray S, Anand K. Reduce the delay in tuberculosis diagnosis in India. The Lancet. 2019;394(10210):1707.
Muttamba W, Kyobe S, Komuhangi A, Lakony J, Buregyeya E, Mabumba E, et al. Delays in diagnosis and treatment of pulmonary tuberculosis in patients seeking care at a regional referral hospital, Uganda: A cross sectional study. BMC Research Notes. 2019;12(1).
Mhalu G, Weiss MG, Hella J, Mhimbira F, Mahongo E, Schindler C, et al. Explaining patient delay in healthcare seeking and loss to diagnostic follow-up among patients with presumptive tuberculosis in Tanzania: a mixed-methods study. BMC Health Services Research. 2019;19(1).
Htwe KK, Kyaw NTT, Kumar AMV, Kyaw KWY, Oo MM, Thwin T, et al. Pre-treatment loss to follow-up and treatment delay among bacteriologically-confirmed tuberculosis patients diagnosed in Mandalay Region, Myanmar. Tropical Medicine and Health. 2019;47(1).
Alema HB, Hailemariam SA, Misgina KH, Weldu MG, Gebregergis YS, Mekonen GK, et al. Health care seeking delay among pulmonary tuberculosis patients in North West zone of Tigrai region, North Ethiopia. BMC Infectious Diseases. 2019;19(1).
Getnet F, Demissie M, Worku A, Gobena T, Seyoum B, Tschop R, et al. Determinants of patient delay in diagnosis of pulmonary tuberculosis in somali pastoralist setting of ethiopia: A matched case-control study. International Journal of Environmental Research and Public Health. 2019;16(18).
Evenden P, Roche A, Karo B, Balasegaram S, Anderson CS. Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome. BMJ Open Respiratory Research. 2019;6(1).
Wikell A, Åberg H, Shedrawy J, Röhl I, Jonsson J, Berggren I, et al. Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: A retrospective observational study. BMC Public Health. 2019;19(1).
Asres A, Jerene D, Deressa W. Delays to anti-tuberculosis treatment intiation among cases on directly observed treatment short course in districts of southwestern Ethiopia: A cross sectional study. BMC Infectious Diseases. 2019;19(1).
Sharma AK, Gupta N, Verma S, Chandran A, Dixit R. A study on procedural delay in diagnosis and start of treatment in drug resistant tuberculosis under RNTCP. Indian Journal of Tuberculosis. 2019;66(3):394-401.
RAND Health Care. Patient Satisfaction Questionnaire from RAND Health Care 2020 [1 March 2020]. https://www.rand.org/health-care/surveys_tools/psq.html].
Chen H, Wang T, Liu L, Wang D, Cheng Q. Trend in risk of delay in diagnosis of new pulmonary tuberculosis in Northwest China from 2008 to 2017. BMC Infectious Diseases. 2019;19(1).
Sheikh S, Afshari M, Mishkar AP. Diagnostic and treatment delay and associated factors in patients with tuberculosis in sistan, Iran. Journal of Mazandaran University of Medical Sciences. 2019;29(175):76-85.
Wang K, Chen S, Wang X, Zhong J, Wang X, Huai P, et al. Factors contributing to the high prevalence of multidrug-resistant tuberculosis among previously treated patients: A case-control study from China. Microbial Drug Resistance. 2014;20(4):294-300.