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Determinants of Treatment Delays among Pulmonary Tuberculosis Patients in Enugu Metropolis, South-East, Nigeria

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DOI: 10.4236/health.2015.711164    2,414 Downloads   3,124 Views   Citations

ABSTRACT

Introduction: Globally, the burden of Tuberculosis is escalating. Early diagnosis and prompt initiation of treatment are essential to achieve an effective tuberculosis control programme. Objective: To investigate the duration of delay for treatment and assess the determinants of treatment delays among pulmonary tuberculosis patients in Enugu metropolis, South-East, Nigeria. Methods: This cross sectional study was conducted among 219 pulmonary tuberculosis patients in six randomly selected DOTS centres in the three LGAs in Enugu metropolis. Data were analysed using SPSS version 17, and statistical significance of association between variables was assessed using Chi-square test at p < 0.05. STATA version 13.1 was used to calculate the positive predictors of TB treatment delays using logistic regression. Ethical clearance was obtained from the Health Research Ethics Committee of UNTH and verbal informed consent was obtained from the participants. Results: Overall, 291 respondents took part in the study, 55.7% were males, 84.4% were aged between 16 to 60 years, while their mean age was 35.4 ± 12.6 years. Most of the participants 32.9%, 26.9%, 15.5% were traders, civil servants, and students respectively. Among the respondents, 3.6% knew that Mycobacterium tuberculosis is the cause of tuberculosis. Among the participants, only 23.3% presented for first appropriate treatment consultation within 1 - 30 days of onset of symptoms. The reasons given by the respondents for the delay are: ignorance of necessity treatment (36.1%), Lack of money (24.2%), no health facility close to the house (13.2%), and other reasons 26.5%. Delay in treatment was found to be significantly associated with HIV status (X2 = 23.412, df = 8, p = 0.003), knowledge of the cause of TB (X2 = 42.322, df = 28, p = 0.040), TB symptoms experienced (X2 = 46.857, df = 20, p = 0.001), occupation (X2 = 34.217, df = 20, p = 0.025), and distance of the health facility from the respondents’ residence (X2 = 34.908, df = 8, p = 0.000). The positive predictors of delayed treatment, using logistic regression, were first presentation at: patent medicine dealer (OR 12.3 CI: 3.22 - 36.23), private hospital (OR 10.6 CI: 5.73 - 17.94), prayer house (OR 7.2 CI: 2.75 - 23.64), and traditional healer (OR 11.9 CI: 6.87 - 32.85). Conclusion: Majority of TB patients in this study did not present early to health facilities. The positive predictors of delayed presentation for appropriate PTB treatment were first presentations at inappropriate treatment centres. There is need to intensify public health awareness among potential TB patients on the associated risks of treatment delay to prevent transmission. Unskilled health care providers should refer suspected PTB patients promptly to facilitate their treatment.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Babatunde, O. , Bismark, E. , Amaechi, N. , Gabriel, E. and Olanike, A. (2015) Determinants of Treatment Delays among Pulmonary Tuberculosis Patients in Enugu Metropolis, South-East, Nigeria. Health, 7, 1506-1516. doi: 10.4236/health.2015.711164.

References

[1] WHO (2013) Global Tuberculosis Control Report. WHO/HTM/TB/2013.16, Geneva.
http://www.who.int/tb/publications/global_report/en
[2] Federal Ministry of Health, Nigeria (2015) National Tuberculosis and Leprosy Control Programme Workers Manual Revised 6th Edition, 1-5.
[3] Fatiregun, A.A. and Ejeckam, C.C. (2010) Determinants of Patient Delay in Seeking Treatment among Pulmonary Tuberculosis Cases in a Government Specialist Hospital in Ibadan, Nigeria. Tanzania Journal of Health Research, 12, 1-9.
http://dx.doi.org/10.4314/thrb.v12i2.56398
[4] Lawn, S.D., Afful, B. and Acheampong, J.W. (1999) Pulmonary Tuberculosis in Adults: Factors Associated with Mortality at a Ghanaian Teaching Hospital. West African Journal of Medicine, 18, 270-274.
[5] World Health Organization (2006) The Stop TB Strategy, Building on and Enhancing DOTS to Meet the TB-related Millennium Development Goals. WHO, Geneva.
[6] Storla, D.G., Yimer, S. and Bjune, G.A. (2008) A Systematic Review of Delay in the Diagnosis and Treatment of Tuberculosis. BMC Public Health, 8, 15.
http://dx.doi.org/10.1186/1471-2458-8-15
[7] World Health Organization (2006) Diagnostic and Treatment Delay in Tuberculosis an In-Depth Analysis of the Health-Seeking Behaviour of Patients and Health System Response in Seven Countries of the Eastern Mediterranean Region. WHO, Geneva.
[8] Paynter, S., Hayward, A., Wilkinson, P., Lozewicz, S. and Coker, R. (2004) Patient and Health Service Delays in Initiating Treatment for Patients with Pulmonary Tuberculosis: Retrospective Study. International Journal of Tuberculosis and Lung Disease, 8, 180-185.
[9] Aoki, M., Mori, T. and Shimao, T. (1985) Studies on Factors Influencing Patient’s, Doctor’s and Total Delay of Tuberculosis Case-Detection in Japan. Bulletin of the International Union against Tuberculosis, 60, 128-132.
[10] Ohmori, M., Ozasa, K., Mori, T., et al. (2005) Trends of Delays in Tuberculosis Case Finding in Japan and Associated Factors. International Journal of Tuberculosis and Lung Disease, 9, 999-1005.
[11] Demissie, M., Lindtjorn, B. and Berhance, Y. (2002) Patient and Health Service Delay in the Diagnosis of Pulmonary Tuberculosis in Ethiopia. BMC Public Health, 2, 23-31.
http://dx.doi.org/10.1186/1471-2458-2-23
[12] Odusanya, O.O. and Babafemi, J.O. (2004) Patterns of Delays amongst Pulmonary Tuberculosis Patients in Lagos, Nigeria. BMC Public Health, 4, 46-51.
[13] Falodun, O.I., Cadmus, E.O., Alabi, P., et al. (2014) Delayed Treatment Seeking Behaviours and Associated Factors among Tuberculosis Patients in Ibadan, Nigeria. African Journal of Epidemiology, 2, 27-33.
[14] Mfinanga, S.G., Mutayoba, B.K., Kahwa, A., et al. (2008) The Magnitude and Factors Associated with Delays in Management of Smear Positive Tuberculosis in Dar es Salam, Tanzania. BMC Public Health, 8, 158.
[15] Raviglione, M. and Uplekar, M. (2006) WHO’s New Stop TB Strategy. The Lancet, 367, 952-955.
http://dx.doi.org/10.1016/S0140-6736(06)68392-X
[16] Endalew, G., Muluken, A. and Gedefaw, A. (2014) Factors Associated with Patient’s Delay in Tuberculosis Treatment in Bahir City Administration, Northwest Ethiopia. BioMed Research International, 2014, Article ID: 701429.
[17] Alexis, C., Andy, R., Mohammed, A.Y. and Luis, E.C. (2007) Duration and Associated Factors of Patient Delay during Tuberculosis Screening in Rural Cameroon. Tropical Medicine and International Health, 12, 1309-1314.
http://dx.doi.org/10.1111/j.1365-3156.2007.01925.x
[18] Tegegn, A. and Yaza-chew, M. (2009) Delays in Tuberculosis Treatment and Associated Factors in Jimma Zone, Southwest Ethiopia. Ethiopian Health Science Journal, 19, 29-37.
[19] Wandwalo, E.R. and Morkve, O. (1998) Delay in Tuberculosis Case Finding and Treatment in Mwanza, Tanzania. International Journal of Tuberculosis and Lung Disease, 2, 635-640.
[20] Enwuru, C.A., Idigbe, E.O., Ezeobi, N.V. and Otegbeye, A.F. (2002) Care-Seeking Behavioural Patterns, Awareness and Diagnostic Pro-cesses in Patients with Smear and Culture-Positive Pulmonary Tuberculosis in Lagos, Nigeria. Transactions of the Royal Society of Tropical Medicine and Hygiene, 96, 614-616.
http://dx.doi.org/10.1016/S0035-9203(02)90328-7
[21] Mesfin, M.M., Newell, J.N., Walley, J.D., Gessessew, A. and Madeley, R.J. (2009) Delayed Consultation among Pulmonary Tuberculosis Patients: A Cross Sectional Study of 10 DOTS Districts of Ethiopia. BMC Public Health, 9, 53.
http://dx.doi.org/10.1186/1471-2458-9-53
[22] Needham, D.M., Godfrey, F.P. and Foster, S.D. (1998) Barriers to Tuberculosis Control in Urban Zambia: Economic Impact and Burden on Patients Prior to Diagnosis. International Journal of Tuberculosis and Lung Disease, 2, 811-817.
[23] Lienhardt, C., Rowley, J., Manneh, K., et al. (2001) Factors Affecting Time Delay to Treatment in a Tuberculosis Control Programme in a Sub-Saharan African Country: The Experience of the Gambia. International Journal of Tuberculosis and Lung Disease, 5, 233-239.
[24] Hoa, N.P., Thorson, A.E.K., Long, N.H. and Diwan, V.K. (2003) Knowledge of Tuberculosis Associated Health-Seeking Behaviour among Rural Vietnamese Adults with a Cough for at Least Three Weeks. Scandinavian Journal of Public Health, 31, 59-65.
http://dx.doi.org/10.1080/14034950310015121
[25] Yamasaki, N.M., Ozasa, K., Yamada, N., et al. (2001) Gender Difference in Delays to Diagnosis and Health Care Seeking Behaviour in a Rural Area of Nepal. International Journal of Tuberculosis and Lung Disease, 5, 24-31.
[26] Giasuddin, A. and Jalaluddin, A. (2004) Gender Difference in Treatment Seeking Behaviours of Tuberculosis Cases in Rural Communities of Bangladesh. National TB Control Programme, Ministry of Health and FW, Dhaka.
[27] Rajeswari, R., Chandrasekaran, V., Suhadev, M., et al. (2002) Factors Associated with Patient and Health System Delays in the Diagnosis of Tuberculosis in South India. International Journal of Tuberculosis and Lung Disease, 6, 789-795.
[28] Falodun, O.I., Cadmus, E.O., Alabi, P., et al. (2014) Delayed Treatment Seeking Behaviours and Associated Factors among Tuberculosis Patients in Ibadan, Nigeria. African Journal of Epidemiology, 2, 27-33.
[29] Pronyk, R.M., Makhubele, M.B., Hargreaves, J.R., Tollman, S.M. and Hausler, H.P. (2001) Assessing Health Seeking Behaviour among Tuberculosis Patients in Rural South Africa. International Journal of Tuberculosis and Lung Disease, 5, 619-627.
[30] Sayoki, G.M., Beatrice, K.M., Amos, K., et al. (2008) The Magnitude and Factors Associated with Delays in Management of Smear Positive Tuberculosis in Dar es Salam, Tanzania. BMC Health Services Research, 8, 8-15.
[31] Balasubramanian, R., Garg, R., Santha, T., et al. (2004) Gender Disparities in Tuberculosis: Report from a Rural DOTS Programme in South India. International Journal of Tuberculosis and Lung Disease, 8, 323-332.
[32] Courtenay, W.H. (2000) Constructions of Masculinity and Their Influence on Men’s Well-Being: A Theory of Gender and Health. Social Science & Medicine, 50, 1385-1401.
http://dx.doi.org/10.1016/S0277-9536(99)00390-1
[33] Zhou, C., Tobe, R.G., Chu, J., et al. (2012) Detection Delay of Pulmonary Tuberculosis Patients among Migrants in China: A Cross-Sectional Study. International Journal of Tuberculosis and Lung Disease, 16, 1630-1636.
http://dx.doi.org/10.5588/ijtld.12.0227
[34] Hussen, A., Biadgilign, S., Tessema, F., et al. (2012) Treatment Delay among Pulmonary Tuberculosis Patients in Pastoralist Communities in Bale Zone, South-East Ethiopia. BMC research Notes, 5, 7-11.
[35] Date, J. and Okita, K. (2005) Gender and Literacy: Factors Related to Diagnostic Delay and Unsuccessful Treatment of Tuberculosis in the Mountainous Area of Yemen. International Journal of Tuberculosis and Lung Diseases, 9, 680-685.

  
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