Vol 14: Patient and heath system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi.Reportar como inadecuado



 Vol 14: Patient and heath system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi.


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This article is from BMC Infectious Diseases, volume 14.AbstractBackground: 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 symptoms 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.



Autor: Makwakwa, Lumbani; Sheu, Mei-ling; Chiang, Chen-Yuan; Lin, Shoei-Loong; Chang, Peter W

Fuente: https://archive.org/







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