Noman Md Zulqarnine Ibne, Islam Shariful, Aktar Shaki, Parray Ateeb Ahmad, Amando Dennis G, Karki Jyoti, Atsna Zafria, Mitra Dipak Kumar, Hossain Shaikh A Shahed
BRAC James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh.
EcoHealth Alliance Bangladesh Programs, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh.
PLOS Glob Public Health. 2024 Jan 24;4(1):e0001903. doi: 10.1371/journal.pgph.0001903. eCollection 2024.
The emergence of Drug-Resistant Tuberculosis (DR-TB) has become a major threat globally and Bangladesh is no exception. Delays in healthcare seeking, proper diagnosis and initiation of treatment cause continuous transmission of the resistant tubercule bacilli through the communities. This study aimed to assess the different health care-seeking behaviors and delays among DR-TB patients in Bangladesh. A prospective cross-sectional study was conducted from November to December 2018, among 92 culture positive and registered DR-TB patients in four selected hospitals in Bangladesh. Data were collected through face-to-face interviews with survey questionnaire as well as record reviews. Among the 92 study participants, the median patient delay was 7 (IQR 3, 15) days, the median diagnostic delay was 88 (IQR 36.5, 210), the median treatment delay was 7 (IQR 4,12) days, and the median total delay among DR-TB patients was 108.5 (IQR 57.5, 238) days. 81.32% sought initial care from informal healthcare providers. The majority (68.48%) of the informal healthcare providers were drug sellers while 60.87% of patients sought care from more than four healthcare points before being diagnosed with DR-TB. The initial care seeking from multiple providers was associated with diagnostic and total delays. In Bangladesh, DR-TB cases usually seek care from multiple providers, particularly from informal providers, and among them, alarmingly higher healthcare-seeking related delays were noted. Immediate measures should be taken both at the health system levels and, in the community, to curb transmission and reduce the burden of the disease.
耐多药结核病(DR-TB)的出现已成为全球的重大威胁,孟加拉国也不例外。就医延迟、正确诊断以及治疗启动延迟导致耐药结核杆菌在社区中持续传播。本研究旨在评估孟加拉国耐多药结核病患者不同的就医行为及延迟情况。2018年11月至12月,在孟加拉国四家选定医院对92例培养阳性且已登记的耐多药结核病患者进行了一项前瞻性横断面研究。通过面对面访谈调查问卷以及记录审查收集数据。在92名研究参与者中,患者中位延迟时间为7(四分位间距3,15)天,中位诊断延迟时间为88(四分位间距36.5,210)天,中位治疗延迟时间为7(四分位间距4,12)天,耐多药结核病患者的中位总延迟时间为108.5(四分位间距57.5,238)天。81.32%的患者最初从非正规医疗服务提供者处寻求治疗。大部分(68.48%)非正规医疗服务提供者是药品销售商,而60.87%的患者在被诊断为耐多药结核病之前从四个以上医疗点寻求过治疗。从多个提供者处寻求初始治疗与诊断延迟和总延迟相关。在孟加拉国,耐多药结核病病例通常从多个提供者处寻求治疗,尤其是从非正规提供者处,并且在这些患者中,发现与就医相关的延迟惊人地高。应立即在卫生系统层面以及社区采取措施,以遏制传播并减轻疾病负担。