Yirgu Robel, Lemessa Firaol, Hirpa Selamawit, Alemayehu Abraham, Klinkenberg Eveline
Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Public Health, College of Health Sciences, Arsi University, Rustavi, Georgia.
BMC Infect Dis. 2017 Apr 20;17(1):292. doi: 10.1186/s12879-017-2407-8.
Early tuberculosis (TB) case finding and adequate chemotherapy are essential for interrupting disease transmission and preventing complications due to delayed care seeking. This study was undertaken in order to provide insights into the magnitude and determinants of patient delay.
The study was conducted in rural Seru district, employing a population based unmatched case-control study design. The WHO standardized TB screening tool was used to identify presumptive TB cases among the district population ages > 15 years. Presumptive TB cases who sought care in a health facility more than 14 days after the onset of symptoms were considered cases while those who sought care within the first 14 days were classified as controls. A structured interview questionnaire was used to capture socio demographic characteristics and health care service utilization related data from the study participants. A multiple binary logistic regression model was used to identify any factor associated with patient care seeking delay.
A total of 9,782 individuals were screened, of which 980 (10%, 95% CI; 9.4-10.5%) presumptive TB cases were identified. From these cases 358 (76%, 95% CI; 75.6%-76.4%) sought care within the first 14 days of the onset of symptoms with a median patient delay of 15 days, IQR (5-30 days). The most common TB suggestive symptom mentioned by the participants was night sweat 754 (76.4%) while the least common was a history of contact with a confirmed TB case in the past one year 207 (21.1%). Individuals in the 45-54 age range had lower odds of delay (AOR 0.31, 95%CI 0.15, 0.61) as compared to those 15-24 years old. First TB treatment episode (AOR16.2, 95% CI 9.94, 26.26) and limited access to either traditional or modern modes of transportation (AOR 2.62, 95% CI 1.25, 5.49) were independently associated with patient care delay.
Increasing community awareness about the risks of delayed care seeking and the importance of accessing health services close to the community can help decrease patient care delay.
早期发现结核病病例并给予充分化疗对于阻断疾病传播以及预防因延迟就医导致的并发症至关重要。开展本研究旨在深入了解患者延迟的程度及其决定因素。
本研究在农村塞鲁区进行，采用基于人群的非匹配病例对照研究设计。使用世界卫生组织标准化结核病筛查工具在15岁以上的地区人群中识别疑似结核病病例。症状出现后14天以上在医疗机构就诊的疑似结核病病例被视为病例，而在症状出现后的前14天内就诊的则被归类为对照。使用结构化访谈问卷收集研究参与者的社会人口学特征和与医疗服务利用相关的数据。采用多元二元逻辑回归模型确定与患者就医延迟相关的任何因素。
共筛查了9782人，其中980例（10%，95%置信区间；9.4 - （此处原文有误，应为9.4 - 10.5%）10.5%）为疑似结核病病例。在这些病例中，358例（76%，95%置信区间；75.6% - 76.4%）在症状出现后的前14天内就医，患者延迟的中位数为15天，四分位间距为（5 - 30天）。参与者提及的最常见的结核病疑似症状是盗汗，有754例（76.4%），而最不常见的是过去一年与确诊结核病病例的接触史，有207例（21.1%）。与15 - 24岁的人群相比，45 - 54岁年龄组的延迟几率较低（调整后比值比为0.31，95%置信区间为0.15，0.61）。首次结核病治疗发作（调整后比值比为16.2，95%置信区间为9.94，26.26）以及获得传统或现代交通方式的机会有限（调整后比值比为2.62，95%置信区间为1.25，5.49）与患者就医延迟独立相关。
提高社区对延迟就医风险以及在社区附近获得医疗服务重要性的认识有助于减少患者就医延迟。
