Said Khadija, Hella Jerry, Mhalu Grace, Chiryankubi Mary, Masika Edward, Maroa Thomas, Mhimbira Francis, Kapalata Neema, Fenner Lukas
Ifakara Health Institute, Bagamoyo Research and Training Centre (BRTC), P O Box 74, Bagamoyo, Tanzania.
Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.
Infect Dis Poverty. 2017 Mar 24;6(1):64. doi: 10.1186/s40249-017-0276-4.
Tanzania is among the 30 countries with the highest tuberculosis (TB) burdens. Because TB has a long infectious period, early diagnosis is not only important for reducing transmission, but also for improving treatment outcomes. We assessed diagnostic delay and associated factors among infectious TB patients.
We interviewed new smear-positive adult pulmonary TB patients enrolled in an ongoing TB cohort study in Dar es Salaam, Tanzania, between November 2013 and June 2015. TB patients were interviewed to collect information on socio-demographics, socio-economic status, health-seeking behaviour, and residential geocodes. We categorized diagnostic delay into ≤ 3 or > 3 weeks. We used logistic regression models to identify risk factors for diagnostic delay, presented as crude (OR) and adjusted Odds Ratios (aOR). We also assessed association between geographical distance (incremental increase of 500 meters between household and the nearest pharmacy) with binary outcomes.
We analysed 513 patients with a median age of 34 years (interquartile range 27-41); 353 (69%) were men. Overall, 444 (87%) reported seeking care from health care providers prior to TB diagnosis, of whom 211 (48%) sought care > 2 times. Only six (1%) visited traditional healers before TB diagnosis. Diagnostic delay was positively associated with absence of chest pain (aOR = 7.97, 95% confidence intervals [CI]: 3.15-20.19; P < 0.001), and presence of hemoptysis (aOR = 25.37, 95% CI: 11.15-57.74; P < 0.001) and negatively associated with use of medication prior to TB diagnosis (aOR = 0.31, 95% CI: 0.14-0.71; P = 0.01). Age, sex, HIV status, education level, household income, and visiting health care facilities (HCFs) were not associated with diagnostic delay. Patients living far from pharmacies were less likely to visit a HCF (incremental increase of distance versus visit to any facility: OR = 0.51, 95% CI: 0.28-0.96; P = 0.037).
TB diagnostic delay was common in Dar es Salaam, and was more likely among patients without prior use of medication and presenting with hemoptysis. Geographical distance to HCFs may have an impact on health-seeking behaviour. Increasing community awareness of TB signs and symptoms could further reduce diagnostic delays and interrupt TB transmission.
坦桑尼亚是结核病负担最高的30个国家之一。由于结核病的传染期很长，早期诊断不仅对减少传播很重要，而且对改善治疗结果也很重要。我们评估了传染性结核病患者的诊断延迟及相关因素。
我们对2013年11月至2015年6月期间在坦桑尼亚达累斯萨拉姆进行的一项正在进行的结核病队列研究中登记的新涂片阳性成年肺结核患者进行了访谈。对结核病患者进行访谈，以收集社会人口统计学、社会经济状况、就医行为和居住地理编码等信息。我们将诊断延迟分为≤3周或>3周。我们使用逻辑回归模型来确定诊断延迟的风险因素，以粗比值比（OR）和调整后的比值比（aOR）表示。我们还评估了地理距离（家庭与最近药房之间每增加500米）与二元结局之间的关联。
我们分析了513例患者，中位年龄为34岁（四分位间距27 - 41岁）；353例（69%）为男性。总体而言，444例（87%）报告在结核病诊断之前曾寻求医疗服务提供者的治疗，其中211例（48%）寻求治疗超过2次。只有6例（1%）在结核病诊断之前看过传统治疗师。诊断延迟与无胸痛（aOR = 7.97，95%置信区间[CI]：3.15 - 20.19；P < 0.001）、咯血（aOR = 25.37，95% CI：11.15 - 57.74；P < 0.001）呈正相关，与结核病诊断之前使用药物呈负相关（aOR = 0.31，95% CI：0.14 - 0.71；P = 0.01）。年龄、性别、艾滋病毒感染状况、教育水平、家庭收入和就诊医疗机构与诊断延迟无关。居住距离药房较远的患者就诊医疗机构的可能性较小（距离增加与就诊任何机构的比值比：OR = 0.51，95% CI：0.28 - 0.96；P = 0.037）。
达累斯萨拉姆的结核病诊断延迟很常见，在未事先使用药物且出现咯血的患者中更有可能发生。到医疗机构的地理距离可能会对就医行为产生影响。提高社区对结核病症状和体征的认识可以进一步减少诊断延迟并阻断结核病传播。
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