Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
Environ Health Prev Med. 2012 Jan;17(1):53-61. doi: 10.1007/s12199-011-0219-9. Epub 2011 May 17.
The aim of this study was to determine the length of delays and to investigate the factors associated with patient (care-seeking) and health-system (treatment initiation following care-seeking) delays, among smear-positive tuberculosis patients in Kunar province, Afghanistan, as delay in diagnosis and treatment results in more severe disease, higher mortality, and a longer period of infectivity in the community.
A cross-sectional study of 122 new smear-positive pulmonary tuberculosis patients, aged ≥15 years, registered at a hospital and a clinic in Kunar province, was conducted from September 2008 to February 2009 using a structured questionnaire interview.
Among the 122 participants, the average patient, health-system, and total delays were 205.2, 150.7, and 356.0 days, respectively. Patient delay was independently associated with an increase in the household size, social stigma linked with tuberculosis (social consequences of having tuberculosis), chest pain, longer time to reach a private health-care facility, initial seeking of alternative services (self-treatment with herbs or drugs; obtaining of drugs from pharmacy or drug store; visiting traditional health provider; and visiting community health worker), and initial consultation with a private health-care facility (p < 0.05). The risk of health-system delays increased with multiple visits and with time to reach private health facilities (p < 0.05). The risk of health-system delays decreased as social stigma increased (p < 0.05).
Delays in the initiation of tuberculosis treatment in Kunar province are daunting. Efforts to reduce delays must encourage early visits, reduce tuberculosis-associated stigma, encourage a public-private health-care mix, improve health-care providers' diagnostic capabilities, and encourage active case-finding with recording of symptoms and screening of contacts.
本研究旨在确定延迟时间，并调查与喀布尔省涂片阳性肺结核患者（寻求治疗）和卫生系统（寻求治疗后开始治疗）延迟相关的因素，因为诊断和治疗的延迟会导致疾病更加严重、死亡率更高，以及在社区中更长的传染性。
2008 年 9 月至 2009 年 2 月，在喀布尔省的一家医院和一家诊所对 122 名新涂片阳性肺结核患者（年龄≥15 岁）进行了一项横断面研究，使用结构化问卷访谈。
在 122 名参与者中，平均患者、卫生系统和总延迟分别为 205.2、150.7 和 356.0 天。患者延迟与家庭规模的增加、与结核病相关的社会耻辱感（患有结核病的社会后果）、胸痛、到达私人医疗保健机构的时间延长、初始寻求替代服务（草药或药物自我治疗；从药房或药店获取药物；传统卫生提供者就诊；以及社区卫生工作者就诊）以及初始咨询私人医疗保健机构（p<0.05）独立相关。随着多次就诊和到达私人医疗机构的时间延长，卫生系统延迟的风险增加（p<0.05）。随着社会耻辱感的增加，卫生系统延迟的风险降低（p<0.05）。
喀布尔省结核病治疗开始时的延迟令人担忧。减少延迟的努力必须鼓励早期就诊、减少与结核病相关的耻辱感、鼓励公私医疗保健混合、提高医疗保健提供者的诊断能力，并鼓励积极发现症状和筛查接触者。
