埃塞俄比亚结核病患者的患者和卫生系统延迟：全国混合方法横断面研究。
Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study.
机构信息
Challenge TB Ethiopia /Management Sciences for Health Ethiopia, box 1157, code 1250, Addis Ababa, Ethiopia.
Management Sciences for Health, Senior Director Infectious Disease Cluster, Arlington, USA.
出版信息
BMC Public Health. 2020 Jul 17;20(1):1126. doi: 10.1186/s12889-020-08967-0.
BACKGROUND
Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia.
METHODS
This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay.
RESULTS
Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10-45), 4 (2-10) and 2 (1-3) days respectively. The median (IQR) of total delay was 33 (19-67) days; 72.3% (595) of the patients started treatment after 21 days of the onset of the first symptom. Poverty, cost of seeking care, protracted diagnostic and treatment initiation, inadequate community based TB care and lack of awareness were associated with delay. Community health workers reported that lack of awareness and the expectation that symptoms would resolve by themselves were the main reasons for delay.
CONCLUSION
TB patients' delay in seeking care remains a challenge due to limited community interventions, cost of seeking care, prolonged diagnostics and treatment initiation. Therefore, targeted community awareness creation, cost reduction strategies and improving diagnostic capacity are vital to reduce delay in seeking TB care in Ethiopia.
背景
有效的结核病（TB）控制是社区提高卫生服务需求和卫生系统及时提供优质 TB 服务的最终结果。卫生服务向周边地区的快速扩张提高了社区的可及性。然而，寻求医疗服务的成本高、与结核病相关的耻辱感、卫生保健工作者的怀疑指数低以及医疗机构缺乏以患者为中心的护理，这些因素导致了获得及时治疗的延迟，从而导致寻求治疗的延迟，进而增加了结核病的传播、发病率和死亡率。我们旨在衡量埃塞俄比亚结核病患者的患者和卫生系统延迟。
方法
这是一项在七个地区和两个城市行政区进行的混合方法横断面研究。我们使用多阶段聚类抽样方法随机选择 40 个卫生中心，并对每个卫生中心的 21 名 TB 患者进行访谈。我们还进行了定性访谈，以了解延迟的原因。
结果
在总共纳入的 844 名 TB 患者中，57.8%为男性。平均（SD）年龄为 34（SD+13.8）岁。46.9%的 TB 患者是家庭的负责人，51.4%已婚，24.1%为农民，34.7%为文盲。患者、诊断和治疗开始延迟的中位数（IQR）分别为 21（10-45）、4（2-10）和 2（1-3）天。总延迟的中位数（IQR）为 33（19-67）天；72.3%（595）的患者在首次出现症状后的 21 天内开始治疗。贫困、寻求医疗服务的成本、诊断和治疗启动时间延长、社区基础 TB 护理不足以及缺乏意识与延迟有关。社区卫生工作者报告说，缺乏意识和认为症状会自行缓解是导致延迟的主要原因。
结论
由于社区干预措施有限、寻求医疗服务的成本高、诊断和治疗启动时间延长，TB 患者寻求医疗服务的延迟仍然是一个挑战。因此，有针对性的社区宣传、降低成本策略和提高诊断能力对于减少埃塞俄比亚结核病患者寻求治疗的延迟至关重要。
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