Determinants of Patients Delay In Pulmonary Tuberculosis Diagnosis in Public Health Centers Of Jimma Zone, Oromia Region South West Ethiopia, 2024: Unmatched Case Control Study

Abstract

Introduction: Tuberculosis remains the top infectious killer in the world claiming close to 4000 lives a day. Ethiopia is among the 30 high-burden TB and TB /HIV countries globally with an estimated tuberculosis incident rate. Delayed presentation is a major problem contributing to the burden and transmission of tuberculosis in most developing countries: Ethiopia has identified less than half of the planned sputum -smear positive cases of tuberculosis. Despite the significant expansion of Tuberculosis services and availability of free diagnosis at health facilities, in Ethiopia delay in Pulmonary tuberculosis patients’ detection and early treatment is a major health problem. Objective: To identify determinants of patient delay in Pulmonary tuberculosis diagnosis at public health centers in Jimma zone, Oromia region south west Ethiopia, 2024. Methods: Unmatched case control study were conducted in randomly selected public health centers implementing direct observations treatment services of Jimma zone Oromia region Ethiopia; from December 2023 to March 2024.Cases were Pulmonary tuberculosis patients who have diagnostic delay following the onset of pulmonary symptoms related to tuberculosis. Controls were patients with similar inclusion criteria as a case except those who sought timely care within 3 weeks onset of symptoms related to pulmonary tuberculosis Cases 129 with 129 controls were interviewed face to face using a pre-tested questionnaire. Data were checked, entered and cleaned in to Epi data 3.1version software, then exported to SPSS version 23 versions. Binary logistic regression was used to fit the data to identify factors associated with patient delay in pulmonary tuberculosis diagnosis. All explanatory variables that are associated with the outcome variable in bivariate analysis with p-value of 0.25 or less were included in the initial logistic regression models of multivariable analysis. Adjusted odds ratios with their corresponding 95% confidence interval were computed. A P-value < 0.05 was considered to declare a result as statistically significance. Results: The study included 124 cases and 128 controls with 98% response rate. After multivariate analysis, sex [AOR=2.46, 95% CI: 1.31-4.63], and place of residence [AOR=2.34, 95% CI: 1.07-5.09], educational status [AOR=6.40, 95% CI: 1.64-14.98 and distance from residency to health facility [AOR=6.77, 95% CI: 2.04-22.5] were identified as the determinants of patient delay of pulmonary tuberculosis diagnosis at a 5% level of significance. Conclusion and Recommendation: The patient delay were the main contributors delay in TB diagnosis. Specific and effective health education programs that focus on the symptoms, prevention and treatment of tuberculosis, the importance of seeking early care and the availability and location of free diagnostic services should carried in the community.