Determinants of Patient Delay in Diagnosis of Pulmonary Tuberculosis in Somali Pastoralist Setting of Ethiopia: A Matched Case-Control Study
Abstract
:1. Background
2. Methods
2.1. Study Setting
2.2. Study Design and Population
2.3. Sample Size and Sampling Technique
2.4. Data Collection
2.5. Measurement of Tuberculosis (TB)-Related Knowledge
2.6. Measurement of Perceived Barriers
2.7. Data Processing and Analysis
2.8. Operational/Standard Definitions of Terms
3. Results
3.1. Socio-Demographic and Clinical Characteristics
3.2. Knowledge and Misconceptions Towards TB
3.3. Healthcare Seeking Behavior
3.4. Determinants of Patient Delay in Diagnosis
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Ethical Approval and Consent to Participate
Data Availability
Consent to Publish
Abbreviations
AOR | Adjusted Odds Ratio |
AFB | Acid Fast Bacilli |
CI | Confidence Interval |
COR | Crude Odds Ratio |
DOTS | Directly Observed Treatment-Short Course |
FMOH | Federal Ministry of Health |
HC | Health Center |
HCP | Health Care Provider |
HEWs | Health Extension Workers |
HF | Health Facility |
HIV | Human Immunodeficiency Virus |
IQR | Inter-Quartile Range |
MDR | Multi-Drug Resistant |
MTB | Mycobacterium tuberculosis |
NTP | National TB Control Program |
PTB | Pulmonary Tuberculosis |
WHO | World Health Organization |
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Characteristics | Frequency (%) | p-Value | |
---|---|---|---|
Controls (n = 226) | Cases (n = 216) | ||
Sex | 0.95 | ||
Female | 84 (37.2) | 81 (37.5) | |
Male | 142 (62.8) | 135 (62.5) | |
Age group (years) | 0.74 | ||
15–23 | 60 (26.5) | 57 (26.4) | |
24–30 | 58 (25.7) | 57 (26.4) | |
31–50 | 60 (26.5) | 64 (29.6) | |
51+ | 48 (21.3) | 38 (17.6) | |
Literacy level | 0.67 | ||
Illiterate | 134 (59.3) | 140 (64.8) | |
Primary | 26 (11.5) | 20 (9.3) | |
Secondary | 34 (15.0) | 30 (13.9) | |
Tertiary | 32 (14.2) | 26 (12.0) | |
Marital status | 0.92 | ||
Single | 67 (29.7) | 65 (30.1) | |
Married | 141 (62.4) | 130 (60.2) | |
Divorced/separated | 8 (3.5) | 9 (4.2) | |
Widowed | 10 (4.4) | 12 (5.5) | |
Residence | 0.04 | ||
Rural | 102 (45.1) | 117 (54.2) | |
Urban | 123 (54.4) | 96 (44.4) | |
Refugee/displaced ᶲᶲ | 1 (0.5) ᶲᶲ | 3 (1.4) ᶲᶲ | |
Livelihood | 0.03 | ||
Pastoralism | 94 (41.6) | 112 (51.9) | |
Non-pastoralism | 132 (58.4) | 104 (48.1) | |
Income | 0.07 | ||
Saving | 29 (12.8) | 28 (13.0) | |
Income = expense | 148 (65.5) | 159 (73.6) | |
Indebt | 49 (21.7) | 29 (13.4) | |
One-way walking time to nearest HF | <0.001 | ||
Within half an hour | 125 (55.3) | 89 (41.2) | |
Half to an hour | 53 (23.5) | 38 (17.6) | |
One to two hours | 24 (10.6) | 36 (16.7) | |
More than two hours | 24 (10.6) | 53 (24.5) | |
Physical conditionat 1st consultation | 0.83 | ||
Good | 34 (15.0) | 29 (13.4) | |
Ambulatory | 185 (81.9) | 180 (83.3) | |
Bedridden | 7 (3.1) | 7 (3.3) | |
Symptoms at disease onset | |||
Cough | 217 (96.0) | 197 (91.2) | 0.04 |
Haemoptysis | 19 (8.4) | 0 | <0.001 |
Chest pain | 134 (59.3) | 119 (55.1) | 0.37 |
Breathing difficulty | 25 (11.1) | 28 (13.0) | 0.53 |
Weight loss | 81 (35.8) | 76 (35.2) | 0.88 |
Night Sweating | 76 (33.6) | 67 (31.0) | 0.56 |
Fatigue | 86 (38.1) | 107 (49.5) | 0.02 |
Fever | 58 (25.7) | 23 (10.7) | <0.001 |
Loss of appetite | 49 (21.7) | 53 (24.5) | 0.47 |
TB category | 0.63 | ||
New | 205 (90.7) | 193 (89.4) | |
Retreatment | 21 (9.3) | 23 (10.6) | |
Smear status | <0.001 | ||
Positive | 76 (3.6) | 111 (51.4) | |
Negative | 150 (66.4) | 105 (48.6) | |
HIV status | 0.27 | ||
Positive | 4 (1.8) | 6 (2.8) | |
Negative | 222 (98.2) | 208 (96.3) | |
Unknown | 0 | 2 (0.9) | |
Pulmonary co-morbidity | 0.27 | ||
None | 221 (97.8) | 206 (95.4) | |
Pneumonia | 3 (1.3) | 7 (3.2) | |
Asthma | 1 (0.4 | 3 (1.4) | |
Bronchitis | 1 (0.4) | 0 | |
Chronic disease (HTN/HD/RD) | 0.36 | ||
Yes | 15 (6.6) | 10 (4.6) | |
None | 211 (93.4) | 206 (95.4) | |
Diabetes mellitus | 0.68 | ||
Yes | 9 (4.0) | 7 (3.2) | |
No | 217 (96.0) | 209 (96.8) |
Characteristics | Controls (≤30 days) | Case (>30 days) | Model 1 | Model 2 | Model 3 | Final Model |
---|---|---|---|---|---|---|
n (%) | n (%) | AOR (95%CI) | AOR (95%CI) | AOR (95%CI) | AOR (95%CI) | |
Socio-demographic factors (Block 1) | ||||||
Educational level | ||||||
Illiterate | 134 (59.3) | 140 (64.8) | 1.4 (0.8,2.5) | |||
Literate (formal) | 92 (40.7) | 76 (35.2) | 1 | |||
Residence | ||||||
Rural | 102 (45.1) | 117 (54.2) | 1.8 (1.04,3.2) | 2.1 (1.3, 3.7) | ||
Urban | 123 (54.4) | 96 (44.4) | 1 | 1 | ||
Refugee/displaced ᶲᶲ | 1 (0.5) ᶲᶲ | 3 (1.4) ᶲᶲ | ᶲᶲ | ᶲᶲ | ||
Livelihood | ||||||
Pastoralism | 94 (41.6) | 112 (51.9) | 1.9 (1.1,3.5) | 2.1 (1.2, 3.6) | ||
Non-pastoralism | 132 (58.4) | 104 (48.1) | 1 | 1 | ||
Income | ||||||
Indebt | 49 (21.7) | 29 (13.4) | 0.5 (0.2,1.1) | |||
Income = expense | 148 (65.5) | 159 (73.6) | 1.1 (0.5,2.0) | |||
Saving | 29 (12.8) | 28 (13.0) | 1 | |||
Family size (average) | ||||||
>6 members | 91 (40.3) | 102 (47.2) | 1.3 (0.9,2.0) | |||
≤6 members | 135 (59.7) | 114 (52.8) | 1 | |||
Smoking (all male, n = 277) | ||||||
Ever smoker | 17 (12.0) | 28 (20.7) | 1.8 (0.9,3.7) | |||
Never smoker | 125 (88.0) | 107 (79.3) | 1 | |||
Khat chewing | ||||||
Ever chewer | 25 (11.1) | 33 (15.3) | 1.7 (0.9,3.3) | |||
Never chewer | 201 (88.9) | 183 (84.7) | 1 | |||
Walking distance to nearest HF | ||||||
More than an hour | 48 (21.2) | 89 (41.2) | 3.2 (1.8,5.6) | 3.2 (1.9,5.6) | ||
Within an hour | 178 (78.8) | 127 (58.8) | 1 | 1 | ||
Knowledge, perceived barriers and Initial Care seeking behavior (Block 2) | ||||||
Knowledge of main TB symptoms | ||||||
Poor | 54 (23.9) | 73 (33.8) | 2.5 (1.4, 4.3) | 2.7 (1.5, 4.8) | ||
Satisfactory | 172 (76.1) | 143 (66.2) | 1 | 1 | ||
TB is owing to evil/bad luck | ||||||
Yes | 48 (21.2) | 59 (27.3) | 1.4 (0.7, 2.6) | |||
No | 178 (78.8) | 157 (72.7) | 1 | |||
Cold air exposure as TB cause | ||||||
Yes | 131 (58.0) | 144 (66.7) | 1.5 (0.9, 2.5) | |||
No | 95 (42.0) | 72 (33.3) | 1 | |||
Hoped illness go- away gradually | ||||||
Yes | 103 (45.6) | 128 (59.3) | 2.0 (1.2, 3.3) | 2.1 (1.3, 3.5) | ||
No | 123 (54.4) | 88 (40.7) | 1 | 1 | ||
First action upon recognized illness | ||||||
Visit HC/Hospital | 180 (79.6) | 158 (73.2) | 1 | |||
Visit low-level HF | 21 (9.3) | 26 (12.0) | 1.2 (0.6, 2.5) | |||
Self/ traditional remedy | 25 (11.1) | 32 (14.8) | 1.03 (0.5, 2.2) | |||
Visit traditional/religious healer | ||||||
Yes | 23 (10.2) | 38 (17.6) | 2.1 (1.1, 4.1) | 2.1 (1.1, 4.2) | ||
No | 203 (89.8) | 178 (82.4) | 1 | 1 | ||
Pulmonary manifestations and co-morbidities (Block 3) | ||||||
Presence of Cough | ||||||
Yes | 217 (96.0) | 196 (90.7) | 0.5 (0.2,1.2) | |||
No | 9 (4.0) | 20 (9.3) | 1 | |||
Symptoms at disease onset (Of 8) | ||||||
Single or two | 72 (31.9) | 89 (41.2) | 1.6 (1.01,2.5) | 1.8 (1.1,2.9) | ||
Three or more | 154 (68.1) | 127 (58.8) | 1 | 1 | ||
Multiplicity of respiratory symptoms * | 1.7 ± 0.7 * | 1.6 ± 0.7 * | 0.6 (0.4,0.9) | 0.5 (0.3,0.7) | ||
Respiratory symptoms (Of 4) | ||||||
Single | 87 (38.5) | 100 (46.3) | 1.7 (1.03,2.8) | 2.2 (1.3,3.9) | ||
Two or more | 139 (61.5) | 116 (53.7) | 1 | 1 | ||
Severity of Disease | ||||||
Mild | 120 (53.1) | 136 (63.0) | 1.6 (1.04,2.5) | 1.6 (1.01,2.6) | ||
Moderate/severe | 106 (46.9) | 80 (37.0) | 1 | 1 | ||
Pulmonary co-morbidity | ||||||
Yes | 5 (2.2) | 10 (4.6) | 2.0 (0.6,6.4) | |||
No | 221 (97.8) | 206 (95.4) | 1 |
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Share and Cite
Getnet, F.; Demissie, M.; Worku, A.; Gobena, T.; Seyoum, B.; Tschopp, R.; Andersen, C.T. Determinants of Patient Delay in Diagnosis of Pulmonary Tuberculosis in Somali Pastoralist Setting of Ethiopia: A Matched Case-Control Study. Int. J. Environ. Res. Public Health 2019, 16, 3391. https://doi.org/10.3390/ijerph16183391
Getnet F, Demissie M, Worku A, Gobena T, Seyoum B, Tschopp R, Andersen CT. Determinants of Patient Delay in Diagnosis of Pulmonary Tuberculosis in Somali Pastoralist Setting of Ethiopia: A Matched Case-Control Study. International Journal of Environmental Research and Public Health. 2019; 16(18):3391. https://doi.org/10.3390/ijerph16183391
Chicago/Turabian StyleGetnet, Fentabil, Meaza Demissie, Alemayehu Worku, Tesfaye Gobena, Berhanu Seyoum, Rea Tschopp, and Christopher T. Andersen. 2019. "Determinants of Patient Delay in Diagnosis of Pulmonary Tuberculosis in Somali Pastoralist Setting of Ethiopia: A Matched Case-Control Study" International Journal of Environmental Research and Public Health 16, no. 18: 3391. https://doi.org/10.3390/ijerph16183391