Department of Development and Sustainability, Regional and Rural Development Planning, Asian Institute of Technology, Pathum Thani, Thailand.
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Am J Trop Med Hyg. 2018 Jul;99(1):143-149. doi: 10.4269/ajtmh.18-0001. Epub 2018 May 10.
Delay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances transmission of tuberculosis (TB) in the community. Therefore, this study aims to assess treatment delay and its associated factors among pulmonary TB patients in Pakistan. A cross-sectional study was conducted among 269 pulmonary TB patients in the district. Binary and multivariate logistic regressions were used to explore the factors associated with delay in TB treatment. Results reveal that most patients were from low socioeconomic backgrounds. For example, 74.7% were living in houses, 54.7% were from lowest the income group (< 250 US$/month), 60.2% married, 54.3% illiterate, 62.5% rural, 56.1% had no house ownership, and 56.5% had insufficient income for daily family expenditures. Significant delays were revealed by this study: 160 patients had experienced a delay of more than 4 weeks, whereas the median delay was 5 weeks. Results show that the most important reason for patient delay was low income and poverty (42.0%) followed by unaware of TB center (41.6), stigma (felt ashamed = 38.7%), and treatment from local traditional healers. Old age (adjusted odds ratio [AOR] = 6.6; 95% confidence interval [CI] = 1.63-26.95); and rural areas patients (AOR = 2.1; 95% CI = 1.15-3.71) were more likely to have experienced delay. However, the higher income and sufficient income category (AOR = 0.5; 95% CI = 0.31-0.95) were associated factors and less likely to experience delay in patient treatment. Integrative prevention interventions, such as those involving community leaders, health extension workers such as lady health workers, and specialized TB centers, would help to reduce delay and expand access to TB-care facilities.
延迟诊断和治疗会使病情恶化并影响临床结局，进而加剧结核病（TB）在社区中的传播。因此，本研究旨在评估巴基斯坦肺结核患者的治疗延迟及其相关因素。本研究采用横断面研究方法，在该地区招募了 269 名肺结核患者。采用二项和多变量逻辑回归分析来探讨与 TB 治疗延迟相关的因素。结果显示，大多数患者来自社会经济地位较低的家庭。例如，74.7%的患者居住在房屋中，54.7%的患者来自收入最低的群体（<250 美元/月），60.2%已婚，54.3%文盲，62.5%来自农村，56.1%没有房屋所有权，56.5%的收入不足以维持家庭日常开支。研究结果显示存在显著的延迟：160 名患者的延迟时间超过 4 周，中位数延迟时间为 5 周。结果表明，患者延迟的最重要原因是低收入和贫困（42.0%），其次是不知道结核病中心（41.6%）、耻辱感（感到羞耻=38.7%）和在当地传统疗愈师处接受治疗。年龄较大（调整后的优势比 [AOR] = 6.6；95%置信区间 [CI] = 1.63-26.95）和农村地区的患者（AOR = 2.1；95% CI = 1.15-3.71）更有可能出现延迟。然而，较高的收入和充足的收入类别（AOR = 0.5；95% CI = 0.31-0.95）是相关因素，患者治疗延迟的可能性较低。综合预防干预措施，如涉及社区领导、卫生推广工作者（如女卫生工作者）和专门的结核病中心的措施，将有助于减少延迟并扩大获得结核病护理设施的机会。
