Hussen Awol, Biadgilign Sibhatu, Tessema Fasil, Mohammed Shikur, Deribe Kebede, Deribew Amare
Bale Zonal Health Department, Oromia Region, Ethiopia.
BMC Res Notes. 2012 Jun 21;5:320. doi: 10.1186/1756-0500-5-320.
Tuberculosis (TB) is a major public health problem in Africa with Ethiopia being the most affected. Treatment delay is an important indicator of access to TB diagnosis and treatment. However, little is known about factors associated with treatment delay of pulmonary TB among pastoralists. Health facility based cross sectional study was conducted on 129 pulmonary TB patients in pastoralist community. The study was conducted in three health centers and a hospital. Time between onset of TB symptoms and first visit to a professional health care provider (patient delay), and the time between first visits to the professional health care provider to the date of diagnosis (provider's delay) were analyzed using SPSS 16.0 statistical software.
A total of 129 new smear positive pulmonary TB patients participated in the study. The median total delay was 97 days. The median patient and health provider delays were 63 and 34 days, respectively. Ninety six percent of the patients were delayed for more than the twenty one days cutoff point. Patient delay was positively associated with first visit to traditional healer/private clinic/drug shop, rural residence, being illiterate, living in more than 10 kilometers from health facility; severity of illness at first presentation to health facility. Provider delay was positively associated with rural residence, being illiterate, patient with good functional status, patients in contact with more than two health providers, and place of first visit being traditional healer/private clinic/drug shop.
This study showed that majority of smear positive patients delayed either for diagnosis or treatment, thus continue to serve as reservoirs of infection. This indicates that there is a need for intervention to decrease patient and provider delays. Effort to reduce delays in pastoralist communities should focus on improving access to services in rural communities, engaging traditional and private health providers and should target illiterate individuals.
结核病是非洲的一个主要公共卫生问题，埃塞俄比亚受影响最为严重。治疗延迟是获得结核病诊断和治疗的一个重要指标。然而，关于牧民中肺结核治疗延迟的相关因素知之甚少。在牧民社区对129例肺结核患者进行了基于卫生设施的横断面研究。该研究在三个卫生中心和一家医院进行。使用SPSS 16.0统计软件分析了结核病症状出现到首次就诊于专业医疗服务提供者的时间（患者延迟），以及首次就诊于专业医疗服务提供者到诊断日期的时间（提供者延迟）。
共有129例新的涂片阳性肺结核患者参与了该研究。总延迟的中位数为97天。患者和医疗服务提供者延迟的中位数分别为63天和34天。96%的患者延迟超过了21天的临界点。患者延迟与首次就诊于传统治疗师/私人诊所/药店、农村居住、文盲、居住在距离卫生设施10公里以上、首次就诊于卫生设施时病情严重程度呈正相关。提供者延迟与农村居住、文盲、功能状态良好的患者、接触过两个以上医疗服务提供者的患者以及首次就诊地点为传统治疗师/私人诊所/药店呈正相关。
本研究表明，大多数涂片阳性患者在诊断或治疗方面存在延迟，因此继续作为传染源。这表明需要进行干预以减少患者和提供者的延迟。减少牧民社区延迟的努力应侧重于改善农村社区的服务可及性，让传统和私人医疗服务提供者参与进来，并应以文盲个体为目标。
