Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana.
Ghana Med J. 2020 Jun;54(2 Suppl):73-82. doi: 10.4314/gmj.v54i2s.12.
We evaluated timeliness and factors influencing treatment initiation (TI) among smear positive pulmonary tuberculosis (PTB+) patients in Brong Ahafo Region (BAR), Ghana.
We conducted a cross-sectional study in health facilities (HF) in six districts in BAR, from November 2014 to May 2015. Newly diagnosed smear positive PTB patients were selected randomly proportionate to size of facility cases. Timeliness of symptoms, diagnosis, TI and factors for delay were assessed using structured questionnaire. Patient delay was defined as presentation to a health care provider after 21 days of the onset of TBrelated symptoms and TI delay as therapy initiated after 30-days of onset of TB-related symptoms. We determined median patient timeliness, HF, and TI timeliness. We identified factors associated with TI delay using logistic regression.
There were a total of 237 PTB+ patients; median patient timeliness of 30 days (IQR:14, 60). The median health facility timeliness was 8 days (IQR:4, 10); and the median TI timeliness was 36 days (IQR:25, 69). Majority (58.7%) of patients delayed in seeking treatment. TI delay was associated with: unemployment [aOR=7.4, 95%CI(1.9-28.8)], fear of losing job [aOR=3.4, 95%CI(1.3-8.5)], traditional healer as first port of call [aOR=10.6, 95%CI(13.0-66.8)], and initially being treated for HIV [aOR=4.9, 95%CI(1.6-14.8)].
There were delays in treatment initiation and patient treatment seeking timeliness. One-third of patients would prefer traditional healers/self-treatment/drug store as an option. A concerted effort by stakeholders is needed to improve behaviour change communication on good health seeking behaviour for persons living with TB to reduce delays in seeking treatment.
The study was funded by the authors.
我们评估了在加纳布隆阿哈福地区（BAR）涂阳肺结核（PTB+）患者中治疗启动的及时性和影响因素。
我们在 2014 年 11 月至 2015 年 5 月期间在 BAR 的六个区的卫生机构（HF）进行了一项横断面研究。根据设施病例的大小，按比例随机选择新诊断的涂阳肺结核患者。使用结构化问卷评估症状、诊断、TI 及时性以及延迟的因素。患者延迟定义为在出现结核病相关症状后 21 天就诊于医疗保健提供者，TI 延迟定义为在出现结核病相关症状后 30 天开始治疗。我们确定了患者及时性的中位数、HF 及时性的中位数和 TI 及时性的中位数。我们使用逻辑回归确定了与 TI 延迟相关的因素。
共有 237 名 PTB+患者；患者及时性的中位数为 30 天（IQR：14，60）。卫生机构及时性的中位数为 8 天（IQR：4，10）；TI 及时性的中位数为 36 天（IQR：25，69）。大多数（58.7%）患者在治疗上存在延迟。TI 延迟与以下因素相关：失业[aOR=7.4，95%CI（1.9-28.8）]、害怕失去工作[aOR=3.4，95%CI（1.3-8.5）]、首先向传统治疗师求医[aOR=10.6，95%CI（13.0-66.8）]和最初因 HIV 接受治疗[aOR=4.9，95%CI（1.6-14.8）]。
治疗启动和患者治疗寻求及时性存在延迟。三分之一的患者更愿意选择传统治疗师/自我治疗/药店作为治疗方案。利益相关者需要共同努力，加强对结核病患者良好健康寻求行为的行为改变沟通，以减少治疗延迟。
该研究由作者资助。
