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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Patient and heath system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi
BMC Infectious Diseases, Volume 14, No. 1, Article 132, Year 2014
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Description
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. © 2014 Makwakwa et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Makwakwa, Lumbani
Taiwan, Taipei
Taipei Medical University
Malawi, Lilongwe
Christian Health Association of Malawi Cham
Sheu, Meiling
Taiwan, Taipei
Taipei Medical University
Chiang, Chenyuan
France, Paris
Departments of Lung Health and Ncds
Taiwan, Taipei
Taipei Municipal Wan-fang Hospital
Taiwan, Taipei
College of Medicine
Lin, Shoei Loong
Taiwan, Taipei
Taipei Hospital
Chang, Wushou Peter
Taiwan, Taipei
Taipei Hospital
Taiwan, Taipei
Taipei Medical University
Statistics
Citations: 60
Authors: 5
Affiliations: 6
Identifiers
Doi:
10.1186/1471-2334-14-132
e-ISSN:
14712334
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Case-Control Study
Study Approach
Quantitative
Study Locations
Malawi