Milkias Habtamu, Yewhalaw Delenasaw, Abebe Gemeda
School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
Federal Ministry of Health, Addis Ababa, Ethiopia.
Arch Public Health. 2023 Apr 4;81(1):50. doi: 10.1186/s13690-023-01071-w.
For presumptive Tuberculosis (TB) case referral to be effective, most of the referred cases need to present themselves to health facilities for assessment and testing. Otherwise, cases of TB could be missed, and these cases are at an increased risk of delayed diagnosis, complications and death. Further, their care incurs significantly higher costs. This study assessed referral compliance as well as factors attributable to compliance/non-compliance to referral of presumptive TB cases in Silti district, Southern Ethiopia.
We applied a mixed design involving both quantitative and qualitative methods. A randomly selected sample of 384 presumptive TB cases referred between January, 2014 and July 2021 were included in this study from the records of 12 health posts. Purposefully selected presumptive TB cases and Health Extension Workers were also interviewed to get in-depth information on the reasons for compliance and non-compliance to referral. STATA version 14 was employed to model the data using logistic regression. Qualitative data were analyzed using thematic content analysis.
Of the 384 referred presumptive TB cases, close to 49% did not present themselves to the referral facilities. About 66% (n = 249) of the referred cases were women, and 62% (n = 119) of those who complied to referral were women. In multivariate analysis, cough [AOR = 3.4, 95%CI: 1.54-7.32], and chest pain [AOR = 2.7, 95%CI: 1.45-5.05] were independent predictors of compliance to referral. Nearly 5.5% (n = 21) of TB cases of all types were identified. The qualitative data analysis revealed that severe disease symptoms, HEW's recommendations, and social issues as reasons improving compliance while personal and social factors, financial problems, lack of awareness about TB and transportation were reasons impeding compliance to referral.
Our study showed a high level of non-compliance to referral among referred presumptive TB cases. We also found that more women were referred and also complied with the referral. Strengthening community awareness about the disease symptoms and the existence of free treatment, addressing misconceptions about TB, supporting the elderly and disabled, and checkup house visits after referral could improve compliance to referral.
为使疑似结核病（TB）病例转诊有效，大多数转诊病例需要前往医疗机构进行评估和检测。否则，可能会漏诊结核病病例，这些病例延迟诊断、出现并发症和死亡的风险会增加。此外，对他们的治疗成本会显著更高。本研究评估了埃塞俄比亚南部锡尔蒂区疑似结核病病例转诊的依从性以及导致依从/不依从转诊的因素。
我们采用了一种涉及定量和定性方法的混合设计。从12个卫生站的记录中，随机抽取了2014年1月至2021年7月期间转诊的384例疑似结核病病例作为本研究的样本。还对特意挑选的疑似结核病病例和卫生推广工作者进行了访谈，以深入了解依从和不依从转诊的原因。使用STATA 14版软件通过逻辑回归对数据进行建模。定性数据采用主题内容分析法进行分析。
在384例转诊的疑似结核病病例中，近49%未前往转诊机构。约66%（n = 249）的转诊病例为女性，在依从转诊的病例中，62%（n = 119）为女性。在多变量分析中，咳嗽[AOR = 3.4，95%CI：1.54 - 7.32]和胸痛[AOR = 2.7，95%CI：1.45 - 5.05]是依从转诊的独立预测因素。共确诊了各类结核病病例的近5.5%（n = 21）。定性数据分析显示，严重的疾病症状、卫生推广工作者的建议以及社会问题是提高依从性的原因，而个人和社会因素、经济问题、对结核病缺乏认识以及交通问题是阻碍依从转诊的原因。
我们的研究表明，在转诊的疑似结核病病例中，不依从转诊的情况很严重。我们还发现转诊的女性更多，并且她们也更依从转诊。加强社区对疾病症状和免费治疗的认识，消除对结核病的误解，为老年人和残疾人提供支持，以及在转诊后进行上门检查，可能会提高转诊的依从性。
