Mesfin Mengiste M, Newell James N, Walley John D, Gessessew Amanuel, Madeley Richard J
Nuffield Centre for International Health and Development, Institute of Health Sciences, University of Leeds, Leeds, UK.
BMC Public Health. 2009 Feb 9;9:53. doi: 10.1186/1471-2458-9-53.
Delays seeking care increase transmission of pulmonary tuberculosis and hence the burden of tuberculosis, which remains high in developing countries. This study investigates patterns of health seeking behavior and determines risk factors for delayed patient consultation at public health facilities in 10 districts of Ethiopia.
New pulmonary TB patients >or= 15 years old were recruited at 18 diagnostic centres. Patients were asked about their health care seeking behaviour and the time from onset of symptoms to first consultation at a public health facility. First consultation at a public health facility 30 days or longer after onset of symptoms was regarded as prolonged patient delay.
Interviews were held with 924 pulmonary patients. Of these, 537 (58%) were smear positive and 387 (42%) were smear negative; 413 (45%) were female; 451 (49%) were rural residents; and the median age was 34 years. Prior to their first consultation at a public health facility, patients received treatment from a variety of informal sources: the Orthodox Church, where they were treated with holy water (24%); private practitioners (13%); rural drug vendors (7%); and traditional healers (3%). The overall median patient delay was 30 days (mean = 60 days). Fifty three percent [95% Confidence Intervals (CI) (50%, 56%)] of patients had delayed their first consultation for >or= 30 days. Patient delay for women was 54%; 95% CI (54%, 58%) and men 51%; 95% CI (47%, 55%). The delay was higher for patients who used informal treatment (median 31 days) than those who did not (15 days). Prolonged patient delay (>or= 30 days) was significantly associated with both patient-related and treatment-related factors. Significant patient-related factors were smear positive pulmonary disease [Adjusted Odds Ratio (AOR) 1.4; 95% CI (1.1 to 1.9)], rural residence [AOR 1.4; 95% CI (1.1 to 1.9)], illiteracy [AOR 1.7; 95% CI (1.2 to 2.4)], and lack of awareness/misperceptions of causes of pulmonary TB. Significant informal treatment-related factors were prior treatment with holy water [AOR 3.5; 95% CI (2.4 to 5)], treatment by private practitioners [AOR 1.7; 95% CI (1.1 to 2.6)] and treatment by drug vendors [AOR 1.9; 95% CI (1.1 to 3.5)].
Nearly half of pulmonary tuberculosis patients delayed seeking health care at a public health facility while getting treatment from informal sources. The involvement of religious institutions and private practitioners in early referral of patients with pulmonary symptoms and creating public awareness about tuberculosis could help reduce delays in starting modern treatment.
就医延迟会增加肺结核的传播，进而加重结核病负担，而这在发展中国家仍然很高。本研究调查了埃塞俄比亚10个地区公共卫生机构中患者寻求医疗行为的模式，并确定了患者延迟就诊的风险因素。
在18个诊断中心招募年龄≥15岁的新发肺结核患者。询问患者其寻求医疗行为以及从症状出现到首次在公共卫生机构就诊的时间。症状出现30天或更长时间后首次在公共卫生机构就诊被视为患者长期延迟。
对924例肺结核患者进行了访谈。其中，537例（58%）涂片阳性，387例（42%）涂片阴性；413例（45%）为女性；451例（49%）为农村居民；中位年龄为34岁。在首次在公共卫生机构就诊之前，患者从各种非正式来源接受治疗：东正教会，在那里他们接受圣水治疗（24%）；私人执业医生（13%）；农村药品供应商（7%）；以及传统治疗师（3%）。患者总体中位延迟时间为30天（平均=60天）。53%[95%置信区间（CI）（50%，56%）]的患者首次就诊延迟≥30天。女性患者延迟为54%；95%CI（54%，58%），男性为51%；95%CI（47%，55%）。使用非正式治疗的患者延迟时间（中位31天）高于未使用非正式治疗的患者（15天）。患者长期延迟（≥30天）与患者相关因素和治疗相关因素均显著相关。显著的患者相关因素为涂片阳性肺结核[调整优势比（AOR）1.4；95%CI（1.1至1.9）]、农村居住[ AOR 1.4；95%CI（1.1至1.9）]、文盲[ AOR 1.7；95%CI（1.2至2.4）]以及对肺结核病因缺乏认识/存在误解。显著的非正式治疗相关因素为先前接受圣水治疗[ AOR 3.5；95%CI（2.4至5）]、由私人执业医生治疗[ AOR 1.7；95%CI（1.1至2.6）]以及由药品供应商治疗[ AOR 1.9；95%CI（1.1至3.5）]。
近一半的肺结核患者在从非正式来源接受治疗时延迟在公共卫生机构寻求医疗服务。宗教机构和私人执业医生参与早期转诊有肺部症状的患者并提高公众对结核病的认识，有助于减少开始现代治疗的延迟。
