Basa Sudipta, Venkatesh S
MPH (FE) Graduate, Department of Epidemiology and Parasitic Diseases, National Center for Disease Control , New Delhi, India .
Joint Director and Head of Department, Department of Epidemiology and Parasitic Diseases, National Center for Disease Control , New Delhi, India .
J Clin Diagn Res. 2016 Sep;10(9):LC21-LC24. doi: 10.7860/JCDR/2016/20136.8567. Epub 2016 Sep 1.
Tuberculosis (TB) is a highly infectious disease which continues to be an important public health problem worldwide.
This study puts an effort to determine patient and health system delay in diagnosis and treatment and association to specific types of delay among tribals in Mayurbhanj district, Odisha.
A total of 261 TB patients reporting to 4 TB Units of Mayurbhanj were interviewed using pre-tested structured questionnaire. Extra-pulmonary TB patients and death cases were excluded. Data entry and analysis was carried out in Epi-info 3.32 version. Chi-square test was used to test the association between dependant variable (patient and health system delays) with different independent variables (age, sex, reasons for delay etc.).
Median patient, health system and total delay were 24, 3 and 24 days respectively. Risk factors that were significantly associated with patient delay were education (95% CI= 1.01-1.11, p=0.015), cost of treatment/transport (95% CI=0.87-1.01, p=0.020), distance (95% CI=1.00-1.29, p=0.002) and lack of awareness about TB (95% CI=1.01-1.34, p=0.001). Health system delay risk factors were distance (95% CI=0.32-0.96, p=0.043), delay due to administrative verification (95% CI=1.18-57.97, p= 0.005) and delay due to traditional healers/ private practitioners (95% CI=1.61-15.45, p=0.0008).
This study revealed longer patient delay compared to health system delay. Therefore, public awareness in tribal dialect about chest symptoms and availability of free diagnostics services should be increased along with involvement of traditional healers.
结核病是一种高度传染性疾病，在全球范围内仍然是一个重要的公共卫生问题。
本研究致力于确定奥里萨邦梅奥尔布汉杰地区部落人群在结核病诊断和治疗过程中的患者延误和卫生系统延误情况，以及与特定类型延误的关联。
使用预先测试的结构化问卷对向梅奥尔布汉杰的4个结核病治疗单位报告的261名结核病患者进行了访谈。排除肺外结核患者和死亡病例。数据录入和分析在Epi-info 3.32版本中进行。卡方检验用于检验因变量（患者延误和卫生系统延误）与不同自变量（年龄、性别、延误原因等）之间的关联。
患者延误、卫生系统延误和总延误的中位数分别为24天、3天和24天。与患者延误显著相关的危险因素包括教育程度（95%可信区间=1.01 - 1.11，p = 0.015）、治疗/交通费用（95%可信区间=0.87 - 1.01，p = 0.020）、距离（95%可信区间=1.00 - 1.29，p = 0.002）以及对结核病缺乏认识（95%可信区间=1.01 - 1.34，p = 0.001）。卫生系统延误的危险因素包括距离（95%可信区间=0.32 - 0.96，p = 0.043）、行政核查导致的延误（95%可信区间=1.18 - 57.97，p = 0.005）以及传统治疗师/私人执业者导致的延误（95%可信区间=1.61 - 15.45，p = 0.0008）。
本研究显示患者延误时间比卫生系统延误时间更长。因此，应提高部落方言中关于胸部症状的公众意识以及免费诊断服务的可及性，并让传统治疗师参与进来。
