Patient and heath system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi

Lumbani Makwakwa, Mei ling Sheu, Chen Yuan Chiang, Shoei Loong Lin, Peter W. Chang

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background:Tuberculosis (TB) control remains a challenge in Malawi despite the National TB Control Program since 1984. This study aimed at measuring patient and health system delays and identifying factors associated with these delays.Methods:A cross-sectional survey of 588 pulmonary TB patients was conducted in three TB centres in Blantyre, Lilongwe, and Mzuzu, between July and December 2011 using a semi-structured questionnaire. Patient delay was defined as the time interval between the onset of TB symptom(s) (a common symptom being coughing) to the first visit to any health provider. Health system delay was the interval from the first care-seeking visit at any health provider to the initiation of anti-tuberculosis treatment. Participants were invited to participate in the study during intensive phase of treatment. The characteristics associated with patient and health system delays were analyzed.Results:The median patient delay was 14 days for both new and retreatment TB cases (interquartile range [IQR] 14 - 28 and 7 - 21, respectively). The median health system delay was 59 days (IQR 26 - 108) for new and 40.5 days (IQR 21-90) for retreatment cases. Factors associated with longer patient delay in new cases included primary education (adjusted odds ratio [AOR] 2.2, 95% CI 1.3 - 3.9) and knowledge that more than three weeks of coughing is a sign of TB (AOR 1.9, 1.1 - 3.3). In retreatment cases, distance >10 Km (AOR 3.3, 1.1 - 9.6) and knowledge that more than three weeks of coughing is a sign of TB (AOR 3.7, 1.3 - 10.7; p <0.05) were significant factors. Making the first visit to a health centre (OR 1.9, 0.9 - 3.8) or a drug store/ traditional healer (OR 5.1, 1.1 - 21.7) in new TB cases were associated with a longer health system delay (p <0.05) while smear negative (OR 6.4, 1.5 - 28.3), and smear unknown or not done (OR 6.1, 1.3 - 26.9) among retreatment cases were associated with a longer health system delay (p <0.05).Conclusions:Effective management and new diagnostic techniques are needed especially among retreatment cases. It is also needed to address geographic barriers to accessing care and increasing TB awareness in the community.

Original languageEnglish
Article number132
JournalBMC Infectious Diseases
Volume14
Issue number1
DOIs
Publication statusPublished - Mar 10 2014

Fingerprint

Malawi
Retreatment
Pulmonary Tuberculosis
Tuberculosis
Health
Odds Ratio
Therapeutics
Cross-Sectional Studies
Education

Keywords

  • Case detection
  • Health system delay
  • Patient delay
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases
  • Medicine(all)

Cite this

Patient and heath system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi. / Makwakwa, Lumbani; Sheu, Mei ling; Chiang, Chen Yuan; Lin, Shoei Loong; Chang, Peter W.

In: BMC Infectious Diseases, Vol. 14, No. 1, 132, 10.03.2014.

Research output: Contribution to journalArticle

@article{7ab038d3fc5e4cdda3702fcbcc608d76,
title = "Patient and heath system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi",
abstract = "Background:Tuberculosis (TB) control remains a challenge in Malawi despite the National TB Control Program since 1984. This study aimed at measuring patient and health system delays and identifying factors associated with these delays.Methods:A cross-sectional survey of 588 pulmonary TB patients was conducted in three TB centres in Blantyre, Lilongwe, and Mzuzu, between July and December 2011 using a semi-structured questionnaire. Patient delay was defined as the time interval between the onset of TB symptom(s) (a common symptom being coughing) to the first visit to any health provider. Health system delay was the interval from the first care-seeking visit at any health provider to the initiation of anti-tuberculosis treatment. Participants were invited to participate in the study during intensive phase of treatment. The characteristics associated with patient and health system delays were analyzed.Results:The median patient delay was 14 days for both new and retreatment TB cases (interquartile range [IQR] 14 - 28 and 7 - 21, respectively). The median health system delay was 59 days (IQR 26 - 108) for new and 40.5 days (IQR 21-90) for retreatment cases. Factors associated with longer patient delay in new cases included primary education (adjusted odds ratio [AOR] 2.2, 95{\%} CI 1.3 - 3.9) and knowledge that more than three weeks of coughing is a sign of TB (AOR 1.9, 1.1 - 3.3). In retreatment cases, distance >10 Km (AOR 3.3, 1.1 - 9.6) and knowledge that more than three weeks of coughing is a sign of TB (AOR 3.7, 1.3 - 10.7; p <0.05) were significant factors. Making the first visit to a health centre (OR 1.9, 0.9 - 3.8) or a drug store/ traditional healer (OR 5.1, 1.1 - 21.7) in new TB cases were associated with a longer health system delay (p <0.05) while smear negative (OR 6.4, 1.5 - 28.3), and smear unknown or not done (OR 6.1, 1.3 - 26.9) among retreatment cases were associated with a longer health system delay (p <0.05).Conclusions:Effective management and new diagnostic techniques are needed especially among retreatment cases. It is also needed to address geographic barriers to accessing care and increasing TB awareness in the community.",
keywords = "Case detection, Health system delay, Patient delay, Tuberculosis",
author = "Lumbani Makwakwa and Sheu, {Mei ling} and Chiang, {Chen Yuan} and Lin, {Shoei Loong} and Chang, {Peter W.}",
year = "2014",
month = "3",
day = "10",
doi = "10.1186/1471-2334-14-132",
language = "English",
volume = "14",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Patient and heath system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi

AU - Makwakwa, Lumbani

AU - Sheu, Mei ling

AU - Chiang, Chen Yuan

AU - Lin, Shoei Loong

AU - Chang, Peter W.

PY - 2014/3/10

Y1 - 2014/3/10

N2 - Background:Tuberculosis (TB) control remains a challenge in Malawi despite the National TB Control Program since 1984. This study aimed at measuring patient and health system delays and identifying factors associated with these delays.Methods:A cross-sectional survey of 588 pulmonary TB patients was conducted in three TB centres in Blantyre, Lilongwe, and Mzuzu, between July and December 2011 using a semi-structured questionnaire. Patient delay was defined as the time interval between the onset of TB symptom(s) (a common symptom being coughing) to the first visit to any health provider. Health system delay was the interval from the first care-seeking visit at any health provider to the initiation of anti-tuberculosis treatment. Participants were invited to participate in the study during intensive phase of treatment. The characteristics associated with patient and health system delays were analyzed.Results:The median patient delay was 14 days for both new and retreatment TB cases (interquartile range [IQR] 14 - 28 and 7 - 21, respectively). The median health system delay was 59 days (IQR 26 - 108) for new and 40.5 days (IQR 21-90) for retreatment cases. Factors associated with longer patient delay in new cases included primary education (adjusted odds ratio [AOR] 2.2, 95% CI 1.3 - 3.9) and knowledge that more than three weeks of coughing is a sign of TB (AOR 1.9, 1.1 - 3.3). In retreatment cases, distance >10 Km (AOR 3.3, 1.1 - 9.6) and knowledge that more than three weeks of coughing is a sign of TB (AOR 3.7, 1.3 - 10.7; p <0.05) were significant factors. Making the first visit to a health centre (OR 1.9, 0.9 - 3.8) or a drug store/ traditional healer (OR 5.1, 1.1 - 21.7) in new TB cases were associated with a longer health system delay (p <0.05) while smear negative (OR 6.4, 1.5 - 28.3), and smear unknown or not done (OR 6.1, 1.3 - 26.9) among retreatment cases were associated with a longer health system delay (p <0.05).Conclusions:Effective management and new diagnostic techniques are needed especially among retreatment cases. It is also needed to address geographic barriers to accessing care and increasing TB awareness in the community.

AB - Background:Tuberculosis (TB) control remains a challenge in Malawi despite the National TB Control Program since 1984. This study aimed at measuring patient and health system delays and identifying factors associated with these delays.Methods:A cross-sectional survey of 588 pulmonary TB patients was conducted in three TB centres in Blantyre, Lilongwe, and Mzuzu, between July and December 2011 using a semi-structured questionnaire. Patient delay was defined as the time interval between the onset of TB symptom(s) (a common symptom being coughing) to the first visit to any health provider. Health system delay was the interval from the first care-seeking visit at any health provider to the initiation of anti-tuberculosis treatment. Participants were invited to participate in the study during intensive phase of treatment. The characteristics associated with patient and health system delays were analyzed.Results:The median patient delay was 14 days for both new and retreatment TB cases (interquartile range [IQR] 14 - 28 and 7 - 21, respectively). The median health system delay was 59 days (IQR 26 - 108) for new and 40.5 days (IQR 21-90) for retreatment cases. Factors associated with longer patient delay in new cases included primary education (adjusted odds ratio [AOR] 2.2, 95% CI 1.3 - 3.9) and knowledge that more than three weeks of coughing is a sign of TB (AOR 1.9, 1.1 - 3.3). In retreatment cases, distance >10 Km (AOR 3.3, 1.1 - 9.6) and knowledge that more than three weeks of coughing is a sign of TB (AOR 3.7, 1.3 - 10.7; p <0.05) were significant factors. Making the first visit to a health centre (OR 1.9, 0.9 - 3.8) or a drug store/ traditional healer (OR 5.1, 1.1 - 21.7) in new TB cases were associated with a longer health system delay (p <0.05) while smear negative (OR 6.4, 1.5 - 28.3), and smear unknown or not done (OR 6.1, 1.3 - 26.9) among retreatment cases were associated with a longer health system delay (p <0.05).Conclusions:Effective management and new diagnostic techniques are needed especially among retreatment cases. It is also needed to address geographic barriers to accessing care and increasing TB awareness in the community.

KW - Case detection

KW - Health system delay

KW - Patient delay

KW - Tuberculosis

UR - http://www.scopus.com/inward/record.url?scp=84897555775&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84897555775&partnerID=8YFLogxK

U2 - 10.1186/1471-2334-14-132

DO - 10.1186/1471-2334-14-132

M3 - Article

C2 - 24606967

AN - SCOPUS:84897555775

VL - 14

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

IS - 1

M1 - 132

ER -