Dept. of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka-1212, Bangladesh.
Dept. of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka-1212, Bangladesh.
Indian J Tuberc. 2020 Oct;67(4):472-478. doi: 10.1016/j.ijtb.2020.07.009. Epub 2020 Jul 16.
Burden of tuberculosis (TB) is still high in Bangladesh. Pre-treatment delay is a hindrance in reducing this burden by early diagnosis and prompt treatment of TB. The study was conducted to identify the patient factors related to pre-treatment delay of pulmonary TB.
This retrospective cohort study was performed during January to June 2018 in a cohort of 240 consecutively enrolled; newly detected adult pulmonary TB (PTB) patients initiated anti-TB therapy during the study period. Two DOTS were selected randomly using cluster sampling and all the PTB patients enrolled in the DOTS centres formed the study population. Informed written consent was obtained from the patients, prior to data collection. Data were collected by face-to-face interview and reviewing medical records using a semi-structured questionnaire and checklist respectively.
Age of the patients was associated with pre-treatment delay of TB (p < 0.05) with predominance in elderly (75.0%). Delay in care seeking was associated with inability to make decision (RR = 1.84; AR: 35.84%) and awareness of patients (RR = 0.33; AR = -40.0%). Delay in diagnosis was associated with economic problem (RR: 1.63; AR: 28.85%); work barrier (RR: 1.75; AR: 35.03%); inability to make decision (RR: 1.93; AR: 40.65%); delayed investigation (RR: 2.88; AR: 56.17%); others' assistance (RR: 1.77; AR: 28.53%); and symptomatic treatment (RR: 6.43; AR: 65.14%). Delay in treatment initiation was associated with repeated investigations (RR = 1.52; AR: 23.29%) and smear positivity (RR: 0.64; AR: 23.11%). Awareness of patients regarding symptoms and smear positivity were revealed as protective factors for pre-treatment delay of TB.
Delay in care seeking, diagnosis, and treatment initiation contribute substantially to pre-treatment delay of PTB. Considerable reduction in pre-treatment delay may be achieved through changes in awareness of patients and ensuring early diagnosis and prompt treatment of PTB under DOTS programme.
结核病（TB）负担在孟加拉国仍然很高。治疗前的延迟是通过早期诊断和及时治疗结核病来减轻这一负担的障碍。本研究旨在确定与肺结核（PTB）治疗前延迟相关的患者因素。
这是一项回顾性队列研究，于 2018 年 1 月至 6 月期间在连续纳入的 240 例新诊断的成年肺结核患者队列中进行。在研究期间，接受了抗结核治疗。使用聚类抽样随机选择了 2 个 DOTS，所有在 DOTS 中心登记的肺结核患者均构成研究人群。在收集数据之前，从患者处获得了知情书面同意。通过面对面访谈和审查病历，分别使用半结构式问卷和检查表收集数据。
患者的年龄与结核病治疗前的延迟有关（p < 0.05），老年人（75.0%）居多。寻求医疗服务的延迟与无法做出决策（RR = 1.84；AR：35.84%）和患者的意识（RR = 0.33；AR：-40.0%）有关。诊断的延迟与经济问题（RR：1.63；AR：28.85%）、工作障碍（RR：1.75；AR：35.03%）、无法做出决策（RR：1.93；AR：40.65%）、延迟调查（RR：2.88；AR：56.17%）、他人协助（RR：1.77；AR：28.53%）和对症治疗（RR：6.43；AR：65.14%）有关。治疗开始的延迟与重复检查（RR = 1.52；AR：23.29%）和涂片阳性（RR = 0.64；AR：23.11%）有关。患者对症状和涂片阳性的认识被揭示为结核病治疗前延迟的保护因素。
寻求医疗服务、诊断和治疗开始的延迟是导致肺结核治疗前延迟的主要原因。通过改变患者的意识，确保 DOTS 计划下的早期诊断和及时治疗，可大大减少治疗前的延迟。
