Delay in initiating tuberculosis treatment and factors associated among pulmonary tuberculosis patients in East Wollega, Western Ethiopia

Abstract

Background: Delay in treatment is also likely to be associated with a greater number of secondary cases per index case. Objective: to assess the length of patient and health system delays; and identify factors influencing these delays among pulmonary tuberculosis patients. Methods: We conducted a cross-sectional study in 13 selected government health facilities that provide both diagnostic and treatment services using Directly Observed Treatment Short course (DOTS) program. Data were collected from pulmonary TB patients aged 15 years and above during their intensive phase of DOTS treatment using a semi-structured questionnaire. Results: The median total delay was 90 days; with 28 days patient delay and 42 days health system delay. A large proportion (63%) of the overall total delay was contributed by health system delay. Patients from urban areas were 46% more likely to present to health care providers than patients from rural areas, adjusted hazard ratio (AHR) of 1.46 (95% CI: 1.10 - 1.95). Patients from urban areas were 54% more likely to be diagnosed and start treatment earlier than patients from rural areas, AHR of 1.54 (95% CI: 1.15-2.07). Female patients were more delayed to present to health providers than their male counterparts with AHR of 0.63 (95%CI: 0.47–0.84) but had shorter health system delay than male patients with AHR of 1.51 (95% CI: 1.1-22.04). Conclusion: A greater proportion of the overall total delay was contributed by health system delay. The health system should be more accessible for the unmet need. New approaches to make health services more accessible to those in greatest need (rural and women) should be designed and developed. [Ethiop.J.Health Dev.2007;21(2):148-156]