Dataset Information

Pulmonary tuberculosis among migrants in Shandong, China: factors associated with treatment delay.

ABSTRACT:

Objective

A timely initiation of treatment is crucial to better control tuberculosis (TB). The aim of this study is to describe treatment delay among migrant patients with TB and to identify factors associated with treatment delay, so as to provide evidence for strategy development and improvement of TB control among migrants in China.

Design

A cross-sectional study was conducted in Shandong province of China. A total of 314 confirmed smear positive migrant patients with pulmonary TB were included. Univariate logistic regression was used to analyse the association of variables with treatment delay among migrant patients with TB. A multilogistic regression model was developed to further assess the effect of variables on treatment delay.

Results

Of 314 migrant patients with TB, 65.6% experienced treatment delay (>1 day). Household income level, diagnosis symptom severity, understanding of whether TB is curable or not and knowledge about the free TB treatment policy are factors significantly associated with treatment delay.

Conclusions

Economic status and knowledge about TB are key barriers to accessing TB treatment. An integrated policy of carrying out TB-related health education and publicising the free TB treatment policy among migrants is needed. Health insurance schemes for migrants should be modified to make them transferrable and pro-poor.

SUBMITTER: Zhou C

PROVIDER: S-EPMC4275669 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

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Publications

Pulmonary tuberculosis among migrants in Shandong, China: factors associated with treatment delay.

Zhou Chengchao C Chu Jie J Geng Hong H Wang Xingzhou X Xu Lingzhong L

BMJ open 20141222 12

<h4>Objective</h4>A timely initiation of treatment is crucial to better control tuberculosis (TB). The aim of this study is to describe treatment delay among migrant patients with TB and to identify factors associated with treatment delay, so as to provide evidence for strategy development and improvement of TB control among migrants in China.<h4>Design</h4>A cross-sectional study was conducted in Shandong province of China. A total of 314 confirmed smear positive migrant patients with pulmonary ...[more]

PMID: 25534210

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Project description:BackgroundDelayed treatment initiation of Tuberculosis patients results in increased infectivity, poor treatment outcome, and increased mortality. However, there is a paucity of evidence on the delay in new adult pulmonary Tuberculosis patients to initiate treatment in Tigray, Northern Ethiopia.ObjectiveTo assess the factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia.MethodsThe study design was cross-sectional. A total of 875 new adult pulmonary tuberculosis patients were recruited from 21 health facilities from October 2018 to October 2019. Health facilities were selected by simple random sampling technique and tuberculosis cases from the health facilities were consecutively enrolled. Data were collected using structured questionnaire within the first 2 weeks of treatment initiation. Delay was categorized as patient, health system and total delays. Data were analyzed using SPSS version 21 and logistic regression was used to identify factors associated with the odds of delays to initiate treatment. A p-value of less than 0.05 was reported as statistically significant.ResultsThe median patient, health system and total delays were 30, 18 and 62 days, respectively. Rural residence, being poor, visiting non-formal medication sources, being primary health care and the private clinic had higher odds of patient delay whereas being HIV positive had lower odds of patient delay. Illiteracy, first visit to primary health care and private clinic had higher odds of health system delay whereas a visit to health facility one time and have no patient delay had lower odds of health system delay.ConclusionThe median patient delay was higher than the median health system delay before initiating treatment. Hence, improved awareness of the community and involving the informal medication sources in the tuberculosis pathways would reduce patient delay. Similarly, improved cough screening and diagnostic efficiency of the lower health facilities would shorten health system delay.

Project description:BackgroundTanzania is among the 30 countries with the highest tuberculosis (TB) burdens. Because TB has a long infectious period, early diagnosis is not only important for reducing transmission, but also for improving treatment outcomes. We assessed diagnostic delay and associated factors among infectious TB patients.MethodsWe interviewed new smear-positive adult pulmonary TB patients enrolled in an ongoing TB cohort study in Dar es Salaam, Tanzania, between November 2013 and June 2015. TB patients were interviewed to collect information on socio-demographics, socio-economic status, health-seeking behaviour, and residential geocodes. We categorized diagnostic delay into ≤ 3 or > 3 weeks. We used logistic regression models to identify risk factors for diagnostic delay, presented as crude (OR) and adjusted Odds Ratios (aOR). We also assessed association between geographical distance (incremental increase of 500 meters between household and the nearest pharmacy) with binary outcomes.ResultsWe analysed 513 patients with a median age of 34 years (interquartile range 27-41); 353 (69%) were men. Overall, 444 (87%) reported seeking care from health care providers prior to TB diagnosis, of whom 211 (48%) sought care > 2 times. Only six (1%) visited traditional healers before TB diagnosis. Diagnostic delay was positively associated with absence of chest pain (aOR = 7.97, 95% confidence intervals [CI]: 3.15-20.19; P < 0.001), and presence of hemoptysis (aOR = 25.37, 95% CI: 11.15-57.74; P < 0.001) and negatively associated with use of medication prior to TB diagnosis (aOR = 0.31, 95% CI: 0.14-0.71; P = 0.01). Age, sex, HIV status, education level, household income, and visiting health care facilities (HCFs) were not associated with diagnostic delay. Patients living far from pharmacies were less likely to visit a HCF (incremental increase of distance versus visit to any facility: OR = 0.51, 95% CI: 0.28-0.96; P = 0.037).ConclusionsTB diagnostic delay was common in Dar es Salaam, and was more likely among patients without prior use of medication and presenting with hemoptysis. Geographical distance to HCFs may have an impact on health-seeking behaviour. Increasing community awareness of TB signs and symptoms could further reduce diagnostic delays and interrupt TB transmission.

Project description:BACKGROUND:Pulmonary tuberculosis (PTB,both smear positive and smear negative) is an airborne infectious disease of major public health concern in China and other parts of the world where PTB endemicity is reported. This study aims at identifying PTB spatio-temporal clusters and associated risk factors in Zhaotong prefecture-level city, located in southwest China, where the PTB notification rate was higher than the average rate in the entire country. METHODS:Space-time scan statistics were carried out using PTB registered data in the nationwide TB online registration system from 2011 to 2015, to identify spatial clusters. PTB patients diagnosed between October 2015 and February 2016 were selected and a structured questionnaire was administered to collect a set of variables that includes socio-economic status, behavioural characteristics, local environmental and biological characteristics. Based on the discovery of detailed town-level spatio-temporal PTB clusters, we divided selected subjects into two groups including the cases that resides within and outside identified clusters. Then, logistic regression analysis was applied comparing the results of variables between the two groups. RESULTS:A total of 1508 subjects consented and participated in the survey. Clusters for PTB cases were identified in 38 towns distributed over south-western Zhaotong. Logistic regression analysis showed that history of chronic bronchitis (OR?=?3.683, 95% CI: 2.180-6.223), living in an urban area (OR?=?5.876, 95% CI: 2.381-14.502) and using coal as the main fuel (OR?=?9.356, 95% CI: 5.620-15.576) were independently associated with clustering. While, not smoking (OR?=?0.340, 95% CI: 0.137-0.843) is the protection factor of spatial clustering. CONCLUSIONS:We found PTB specially clustered in south-western Zhaotong. The strong associated factors influencing the PTB spatial cluster including: the history of chronic bronchitis, living in the urban area, smoking and the use of coal as the main fuel for cooking and heating. Therefore, efforts should be made to curtail these associated factors.

Project description:ObjectiveThis study was designed to identify the risk factors for drug-resistant tuberculosis (DR-TB) and the association between comorbidity and drug resistance among retreated pulmonary tuberculosis (PTB).DesignA retrospective study was conducted among all the 36 monitoring sites in Shandong, China, over a 16-year period. Baseline characteristics were collected from the TB Surveillance System. Categorical variables were compared by Fisher's exact or Pearson's χ2 test. The risk factors for drug resistance were identified using univariable analysis and multivariable logistic models. The influence of comorbidity on different types of drug resistance was evaluated by performing multivariable logistic models with the covariates adjusted by age, sex, body mass index, drinking/smoking history and cavity.ResultsA total of 10 975 patients with PTB were recorded during 2004-2019, and of these 1924 retreated PTB were finally included. Among retreated PTB, 26.2% were DR-TB and 12.5% had comorbidity. Smoking (adjusted OR (aOR): 1.69, 95% CI 1.19 to 2.39), cavity (aOR: 1.55, 95% CI 1.22 to 1.97) and comorbidity (aOR: 1.44, 95% CI 1.02 to 2.02) were risk factors for DR-TB. Of 504 DR-TB, 9.5% had diabetes mellitus, followed by hypertension (2.0%) and chronic obstructive pulmonary disease (1.8%). Patients with retreated PTB with comorbidity were more likely to be older, have more bad habits (smoking, alcohol abuse) and have clinical symptoms (expectoration, haemoptysis, weight loss). Comorbidity was significantly associated with DR-TB (aOR: 1.44, 95% CI 1.02 to 2.02), overall rifampin resistance (aOR: 2.17, 95% CI 1.41 to 3.36), overall streptomycin resistance (aOR: 1.51, 95% CI 1.00 to 2.27) and multidrug resistance (aOR: 1.96, 95% CI 1.17 to 3.27) compared with pan-susceptible patients (p<0.05).ConclusionSmoking, cavity and comorbidity lead to an increased risk of drug resistance among retreated PTB. Strategies to improve the host's health, including smoking cessation, screening and treatment of comorbidity, might contribute to the control of tuberculosis, especially DR-TB, in China.

Project description:Background:TB is an infectious disease caused by the bacillus Mycobacterium TB complex. It is a major public health concern causing devastating illness in millions of people each year and one of the top 10 causes of death worldwide following HIV pandemic. It demands huge costs each year for prevention, diagnosis, and treatment of TB. Global TB control progress depends on major advances in early diagnosis and treatment. Despite progress in providing diagnosis and preventive treatment of TB, big detection and treatment gaps remained with delayed diagnosis and treatment of TB especially in resource-limited countries. This is mainly because of factors related to the patient and health care system including sociodemographic, economic, and cultural barriers to accessing TB care. Objective:The study conducted in Gedeo Zone, Southern Ethiopia, had the primary purpose of identifying the median delay in starting a correct TB treatment and the associated factors for such a delay in patients newly diagnosed with PTB in selected health facilities of Gedeo Zone, Southern Ethiopia, 2017/18. Methods:Institutional based cross-sectional study was conducted among new pulmonary TB patients in selected health institution of Gedeo Zone, Southern Ethiopia, 2017, from October, 2017, to May, 2018. All new pulmonary TB patients who fulfill the inclusion criteria during the study period were included in the study after informed consent was obtained from the participants. Data was cleaned, coded, and entered into SPSS version 20 for analysis. A frequency for variables was calculated. Chi-square was used to screen the possible potential associated factors and multivariate analysis was used to ascertain the association between variables. All statistical tests values of p<0.05 were considered as statistically significant. Result:The median total in treatment of TB was 60 days. Among the total study participants, 50.9% of the participants have unacceptable/longer total delay in TB treatment. Being of female gender, not attending formal education, having rural residency, having poor knowledge of TB, having home distance >10Km from the nearest health facility, visiting nonformal health care provider, and taking antibiotic treatment before TB diagnosis empirically were identified as significant independently associated factors for unacceptable total treatment in TB. Conclusions:There was higher median total delay in treatment of TB (60 days) and an overall prevalence of 50.9% unacceptable/longer total delay in treatment of TB. Female gender, rural residence, not attending formal education, visiting nonformal health facility as first health care seeking, having poor knowledge of TB, and having antibiotic treatment before TB diagnosis were identified as independent significant associated factors.

Dataset Information

Pulmonary tuberculosis among migrants in Shandong, China: factors associated with treatment delay.

Objective

Design

Results

Conclusions

Publications

Pulmonary tuberculosis among migrants in Shandong, China: factors associated with treatment delay.

Similar Datasets

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