MAGNITUDE OF PATIENT AND HEALTH SYSTEM DELAYS AND ASSOCIATED FACTORS AMONG TUBERCULOSIS PATIENTS IN GAMO ZONE PUBLIC HEALTH FACILITIES, SOUTHERN ETHIOPIA.

Abstract

Background: Delayed tuberculosis (TB) diagnosis and treatment increase morbidity, mortality, expenditure, and transmission in the community. Early diagnosis and initiation of treatment is essential for effective TB control. Objective: The main objective of this study was to assess the magnitude and factors associated with patient and health system delay among tuberculosis patients in Gamo Zone, Southern Ethiopia, 2019. Methods: A cross-sectional study was conducted in Gamo Zone, Southern Ethiopia from February to April 2019. Fifteen health facilities of study area were selected randomly and 255 TB patients who were ≥18 years of age included. Data were collected using a questionnaire through face-to-face interview and analyzed using SPSS version 20.0. Delay was analyzed at two levels (patient and health system) using median as cut-off. Logistic regression analysis was performed to investigate factors of delays. A p-value of ≤ 0.05 at multivariate analysis was considered statistically significa30(15-60) and 14(6-30) days, respectively. About 56.9% and 54.5% of patients had prolonged patients’ and health system delay, respectively. Patient whose first action were informal provider (adjusted odds ratio [AOR]: 2.24; 95% confidence interval [CI] 1.29, 3.86), presenting with weight loss (AOR: 2.53; 95%CI: 1.35, 4.74) and fatigue (AOR: 2.38; 95%CI: 1.36, 4.17) and body mass index (BMI) categories of underweight (AOR: 1.74; 95%CI: 1.01, 3.00) were independently associated with increased odds of patient delay. However, having good knowledge about TB (AOR: 0.44; 95% CI: 0.26, 0.76) significantly reduce patients’ delay. Patients who had multiple healthcare contacts (AOR: 5.74; 95% CI: 2.47, 13.34) and age between 25-44 years old (AOR: 1.98; 95% CI: 1.02, 3.86) and aged ≥45 years (AOR: 3.54; 95% CI: 2.17, 14.27) were significantly associated with longer health system’s delay. However, female gender (AOR: 0.46; 95% CI: 0.25, 0.87) and patients presenting symptoms [Hemoptysis (AOR: 0.27; 95%CI: 0.11, 0.65) and Chest pain (AOR: 0.28; 95%CI; 0.14, 0.56)] were significantly associated with reduced health system’s delay. Conclusion and recommendations: In this study, it was observed that a significant proportion of patients experienced more than the acceptable level for patient and health care system delay. Knowledge about TB, first action to illness, presenting symptoms and BMI status were observed factors associated with patient delay and number of health care nt. treatment(2-4). The delays in health care seeking for TB related symptoms are neglected due to both patient and provider factors(1, 5). Studies from multiple countries have identified various factors associated with delay in TB diagnosis and treatment, with significant variation. Factors differ according to social and cultural issues, local TB and Human Immunodeficiency Virus (HIV) prevalence, and characteristics of public health systems. Delays in seeking health care and in providing early diagnosis and treatment increase the risk of disease transmission and subsequently lead to death. TB diagnosis and treatment are delayed when patients wait until long after the onset of symptom to seek care (patient delay), or when care providers take too long to diagnose and treat the patients who sought care (health system delay)(3). The length of delay was significantly longer among low and middle-income countries than in the developed nations. In most studies conducted elsewhere, it was noted that patient delay was longer than health system delay (6-8). Since 1993, TB has been recognized as a global public health problem, different global strategies have been designed and implemented for the control of TB, including Directly Results: The median (inter-quartile range) of patient and health system delays were