Mhalu Grace, Weiss Mitchell G, Hella Jerry, Mhimbira Francis, Mahongo Enos, Schindler Christian, Reither Klaus, Fenner Lukas, Zemp Elisabeth, Merten Sonja
Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
BMC Health Serv Res. 2019 Apr 5;19(1):217. doi: 10.1186/s12913-019-4030-4.
Delay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality. We examined factors, including perceived causes and prior help seeking, contributing to delay and LDFU during referral to a TB clinic among patients with presumptive TB initially seeking help at the pharmacies in Dar es Salaam Tanzania.
In a TB clinic, a semi-structured interview based on the explanatory model interview catalogue (EMIC) framework for cultural epidemiology was administered to presumptive TB patients enrolled at pharmacies during an intervention study. We assessed delay in seeking care at any medical care provider for a period of ≥3 weeks after the onset of symptoms, LDFU during referral (not reaching the TB clinic), and LDFU for three required TB clinic visits among the presumptive and confirmed TB patients. Logistic regression models were used to assess factors associated with delay and LDFU.
Among 136 interviewed patients, 86 (63.2%) were LDFU from pharmacies and TB clinic while 50 (36.8%) were non-LDFU. Out of 136 patients 88 (64.7%) delayed seeking care, of whom 59 (67%) were females. Among the 86 (63.2%) patients in LDFU group, 62 (72.1%) delayed seeking care, while among the 50 (36.8%) non-LDFU, 26 (52.0%) had also delayed seeking care. Prior consultation with a traditional healer (aOR 2.84, 95% CI 1.08-7.40), perceived causes as ingestion (water and food) (aOR 0.38 CI 0.16-0.89), and substance use (smoking and alcohol) (aOR 1.45 CI 0.98-2.14) were all associated with patient delay. Female gender was associated with LDFU (aOR 3.80, 95% CI 1.62-8.87) but not with delay. Other conditions as prior illness and heredity were also associated with LDFU but not delay (aOR 1.48 CI 1.01-2.17).
Delay and LDFU after referral from the pharmacies were substantial. Notable effects of diagnosis and female gender indicate a need for more attention to women's health to promote timely and sustained TB treatment. Public awareness to counter misconceptions about the causes of TB is needed.
就医延迟和诊断随访失访（LDFU）导致结核病（TB）发病率和死亡率大幅上升。我们研究了一些因素，包括感知到的病因和先前的求助情况，这些因素导致坦桑尼亚达累斯萨拉姆市在药房初步寻求帮助的疑似结核病患者转诊至结核病诊所期间出现延迟和LDFU。
在一项干预研究中，对在药房登记的疑似结核病患者进行了基于文化流行病学解释模型访谈目录（EMIC）框架的半结构化访谈。我们评估了症状出现后≥3周内在任何医疗服务提供者处寻求治疗的延迟情况、转诊期间的LDFU（未到达结核病诊所）以及疑似和确诊结核病患者在结核病诊所进行三次所需就诊时出现的LDFU。使用逻辑回归模型评估与延迟和LDFU相关的因素。
在136名接受访谈的患者中，86名（63.2%）在从药房到结核病诊所的过程中出现LDFU，而有50名（36.8%）未出现LDFU。在136名患者中，88名（64.7%）延迟寻求治疗，其中59名（67%）为女性。在86名（63.2%）LDFU组患者中，62名（72.1%）延迟寻求治疗，而在50名（36.8%）未出现LDFU的患者中，26名（52.0%）也延迟寻求治疗。先前咨询过传统治疗师（调整后比值比[aOR]2.84，95%置信区间[CI]1.08 - 7.40）、认为病因是摄入（水和食物）（aOR 0.38，CI 0.
