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Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis.

ABSTRACT: BACKGROUND:Delay in the diagnosis of Tuberculosis (TB) remains a major challenge against achieving effective TB prevention and control. Though a number of studies with inconsistent findings were conducted in Ethiopia; unavailability of a nationwide study determining the median time of patient delays to TB diagnosis is an important research gap. Therefore, this study aimed to determine the pooled median time of the patient delay to TB diagnosis and its determinants in Ethiopia. METHODS:We followed PRISMA checklist to present this study. We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. The comprehensive search for relevant studies was done by two of the authors (MA and LY) up to the 10th of October 2019. Risk of bias was assessed using the Newcastle-Ottawa scale adapted for observational studies. Data were pooled and a random effect meta-analysis model was fitted to provide the overall median time of patient delay and its determinants in Ethiopia. Furthermore, subgroup analyses were conducted to investigate how the median time of patient delay varies across different groups of studies. RESULTS:Twenty-four studies that satisfied the eligibility criteria were included. Our meta-analysis showed that the median time of the patient delay was 24.6 (95%CI: 20.8-28.4) days. Living in rural area (OR: 2.19, 95%CI: 1.51-3.18), and poor knowledge about TB (OR: 2.85, 95%CI: 1.49-5.47) were more likely to lead to prolonged delay. Patients who consult non-formal health providers (OR: 5.08, 95%CI: 1.56-16.59) had a prolonged delay in the diagnosis of TB. Moreover, the narrative review of this study showed that age, educational level, financial burden and distance travel to reach the nearest health facility were significantly associated with a patient delay in the diagnosis of TB. CONCLUSIONS:In conclusion, patients are delayed more-than three weeks in the diagnosis of TB. Lack of awareness about TB, consulting non-formal health provider, and being in the rural area had increased patient delay to TB diagnosis. Increasing public awareness about TB, particularly in rural and disadvantaged areas could help to early diagnosis of TB.

SUBMITTER: Alene M

PROVIDER: S-EPMC7590610 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis.

Alene Muluneh M Assemie Moges Agazhe MA Yismaw Leltework L Gedif Getnet G Ketema Daniel Bekele DB Gietaneh Wodaje W Chekol Tadele Demilew TD

BMC infectious diseases 20201027 1

<h4>Background</h4>Delay in the diagnosis of Tuberculosis (TB) remains a major challenge against achieving effective TB prevention and control. Though a number of studies with inconsistent findings were conducted in Ethiopia; unavailability of a nationwide study determining the median time of patient delays to TB diagnosis is an important research gap. Therefore, this study aimed to determine the pooled median time of the patient delay to TB diagnosis and its determinants in Ethiopia.<h4>Methods ...[more]

PMID: 33109110

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Project description:BackgroundDelayed presentation is a major problem contributing to the high burden and transmission of tuberculosis (TB) in developing countries. The delay may be due to patient delay if the patient visits health-facility for diagnosis after the onset of symptoms of more than 3 weeks or health system delay if the patient is not diagnosed and treated at the time of the first visit. Ethiopia, where no more than two-thirds of TB cases are detected is no exception. Therefore, the aim of this study was to assess delay in diagnosis of tuberculosis among patients taking anti-TB treatment in North Shoa Zone, Ethiopia.MethodsInstitution based cross-sectional study was conducted from 01 to 30 December 2017. All TB patients who took their treatment in the health facilities of the seven selected districts of North Shoa Zone were included. Data was entered into EPI INFO version 3.5.1 statistical software and transferred into SPSS version 20.0 for further analysis. Bivariate and multivariate analysis was used to identify associated factors for delayed TB diagnosis.ResultsOut of 170 tuberculosis patients included, 162 patients were studied with a response rate of 95.3%. The proportion of tuberculosis patients who had delayed diagnosis was 59.9%. The mean time of health-seeking after developing the symptom of tuberculosis was 7.6 weeks. Tuberculosis patients with extra pulmonary site involvements were about four times more likely to be delayed in seeking health services (OR: 4.00, 95% CI: 1.77-9.03) as compared to patients with pulmonary TB. New patients were about three times more likely to come lately for TB diagnosis (OR: 2.94, 95% CI: 1.26-6.84) as compared to patients who had previous-history of treatment. Patients who had no information about TB before they started TB treatment were also around three times to be delayed (OR: 3.37, 95% CI: 1.43-8.00) as compared to those who had the information.ConclusionsMore than 50% of TB patients reported in health-seeking relatively a longer time. Strengthening the health education activities for the community about tuberculosis and capacity building of the health care provider to increase suspicion of identifying tuberculosis and early diagnosis is crucial.

Project description:BackgroundTuberculosis (TB) which is caused by Mycobacterium tuberculosis poses a significant public health global treat. Tuberculosis meningitis (TBM) accounts for approximately 1% of all active TB cases. The diagnosis of Tuberculosis meningitis is notably difficult due to its rapid onset, nonspecific symptoms, and the difficulty of detecting Mycobacterium tuberculosis in cerebrospinal fluid (CSF). In 2019, 78,200 adults died of TB meningitis. This study aimed to assess the microbiological diagnosis TB meningitis using CSF and estimated the risk of death from TBM.MethodsRelevant electronic databases and gray literature sources were searched for studies that reported presumed TBM patients. The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal tools designed for prevalence studies. Data were summarized using Microsoft excel ver 16. The proportion of culture confirmed TBM, prevalence of drug resistance and risk of death were calculated using the random-effect model. Stata version 16.0 was used perform the statistical analysis. Moreover, subgroup analysis was conducted.ResultsAfter systematic searching and quality assessment, 31 studies were included in the final analysis. Ninety percent of the included studies were retrospective studies in design. The overall pooled estimates of CSF culture positive TBM was 29.72% (95% CI; 21.42-38.02). The pooled prevalence of MDR-TB among culture positive TBM cases was 5.19% (95% CI; 3.12-7.25). While, the proportion of INH mono-resistance was 9.37% (95% CI; 7.03-11.71). The pooled estimate of case fatality rate among confirmed TBM cases was 20.42% (95%CI; 14.81-26.03). Based on sub group analysis, the pooled case fatality rate among HIV positive and HIV negative TBM individuals was 53.39% (95%CI; 40.55-66.24) and 21.65% (95%CI;4.27-39.03) respectively.ConclusionDefinite diagnosis of TBM still remains global treat. Microbiological confirmation of TBM is not always achievable. Early microbiological confirmation of TBM has great importance to reduce mortality. There was high rate of MDR-TB among confirmed TBM patients. All TB meningitis isolates should be cultured and drug susceptibility tested using standard techniques.

Project description:BackgroundTreatment seeking delay is defined as the time interval between the onset of the major symptoms of tuberculosis (TB) and the first visit to the formal health care facility. The patient was said to be delayed if the patient visited the health-facility after 3 weeks onset of major symptoms. However, in low-income countries like Ethiopia, the delay in treatment-seeking among tuberculosis patients contributes to a widespread transmission and high prevalence of tuberculosis.MethodsStudies were retrieved from PubMed, Cochrane Database, Cinahl, Scopus, Mednar, and Google Scholar by employing a combination of search terms with Boolean operators. Heterogeneity across studies was assessed using the Cochrane Q test. A funnel plot was used for visual assessment of publication bias. Subgroup analyses were performed to explore the possible causes of heterogeneity. Egger's weighted regression test at a p-value < 0.05 was used to assess the presence of publication bias. Sensitivity analysis was performed to judge whether the pooled effect size was influenced by individual study. STATA software version 14 was used for all statistical analyses.ResultA total of 12 studies with 5122 total sample size were included. The national pooled prevalence of treatment seeking delay was 44.29% (95% CI: 39.805, 48.771). The visual inspection of the funnel plot showed the asymmetrical distribution, and the Egger test showed insignificant (P = 0.348). Patients who did not seek formal health care providers on a first contact had about 7 times more likely to delay than patients who sought formal health care provider on a first contact (OR: 7.192 ((95% CI 5.587-9.257), P = 0.001, I2: 85%). The others independent predictors of delay were rural residence (OR: 3.459 ((95% CI 1.469-8.148), P ≤ 0.001), extra pulmonary TB (OR: 2.520 ((95% CI 1.761-3.605), 0.180), lower educational level (OR 11.720 ((95% CI 1.006-2.938), P <0.001), and distance more than 10km from health facility (OR: 1.631 ((95% CI (10.858-3.101), P = 0.001).ConclusionIn this review, we identified a substantial treatment seeking delay among TB patients in Ethiopia. And, the independent predictors of delay were treatment sought before formal health care provider, residence of the patient, type of TB, educational level, and distance from a health facility. Thus, we recommend health extension workers, health professionals and other stakeholders to focus on patient education, and to continuously mobilize the whole communities on early treatment seeking with a special emphasis given to where treatment sought before formal health care provider, rural resident, extra pulmonary TB, and a patient living farther than 10km distance from health facility.

Project description:Except individual studies with varying prevalence rates, there are no national prevalence studies conducted in prison settings in Ethiopia. Appropriate estimates of the disease is essential to formulate health service plans most fitted for prisoners. Therefore, this systematic review and meta-analysis was designed to pool the results of individual studies and estimate the prevalence of tuberculosis among prisoners in Ethiopia.MEDLINE/PubMed, Cochran library, and Google scholar databases were searched for potential studies on the prevalence of tuberculosis among prisoners in Ethiopia. A total of 177 titles were identified and 10 studies met the inclusion criteria. Descriptive and quantitative data of the included studies were presented in tables and forest plots. Potential sources of heterogeneity across studies were assessed using the Cochrane's Q and I2 tests. The MetaXL (version 5.3) was employed to compute the pooled prevalence of TB using the random effect model and 95% confidence interval.Based on the ten studies included in the meta-analysis, about 4086 prisoners were infected with tuberculosis (TB). The pooled prevalence of TB among prisoners was therefore 8.33% (95% CI; 6.28%-10.63%) and the pooled point prevalence was estimated at 888 per 100,000 prison population (95% CI; 531-1333). The prevalence of TB using microscopy alone was 6.59% (95% CI: 3.96-9.50%) whereas the prevalence of TB when microscopy is combined with either culture or molecular tests was 8.57% (95% CI: 4.94-12.6%).The pooled prevalence of tuberculosis among prisoners in Ethiopia is expectedly high. This high prevalence could explain the spread of TB within prisons and between prisoners and varies communities. Thus; attention should be given to prison settings to prevent the transmission and emergence of drug resistance TB both in inmates and general population. Further studies covering large scale prison population are needed to design effective diagnostic, treatment and preventive methods.

Project description:BackgroundTuberculosis and intestinal parasites are mostly affecting poor people. They are in a vicious since one is the risk factor for the other. However, the comprehensive report on the burden and co-incidence of intestinal parasites and tuberculosis in Ethiopia is scant. This systematic review and meta-analysis aimed to provide abridge conclusive evidence on the intestinal parasite-tuberculosis co-infection in Ethiopia.MethodsA total of 414 articles published in English were searched from both electronic databases (CINAHL, DOAJ, Embase, Emcare, Medline, ProQuest, and PubMed, Science Direct, and Web of Science) and other sources. The qualities of the included studies were assessed using the Joanna Briggs Institute Critical Appraisal tools and the publication bias was measured using the funnel plot and Eggers regression test. Comprehensive meta-analysis (CMA) Version 3.3.07 and Review Manager software were used to estimate pooled prevalence and associations of intestinal parasites and tuberculosis infection.ResultsEleven articles with a total of 3158 tuberculosis patients included in the analysis based on the eligibility criteria. The estimated pooled prevalence of intestinal parasites co-infection was 33% (95% CI: 23.3, 44.3) using the random-effects model. The most common intestinal parasites were Ascaris lumbricoides 10.5% (95% CI: 6.0, 17.5), Hookworm 9.5% (95% CI: 6.10, 14.4), Giardia lamblia 5.7% (95% CI: 2.90, 10.9) and Strongyloides sterocoralis 5.6% (95% CI: 3.3, 9.5). The odds of intestinal parasites infection was higher among tuberculosis patients compared to tuberculosis free individuals (OR = 1.76; 95% CI: 1.17, 2.63). A significant difference was observed among TB patients for infection with intestinal helminths (OR = 2.01; 95% CI: 1.07, 3.80) but not for intestinal protozoans when compared with their counterparts. The odds of multiple parasitic infections was higher among tuberculosis patients (OR = 2.59, 95% CI: 1.90, 3.55) compared to tuberculosis free individuals. However, intestinal parasites co-infection was not associated with HIV status among tuberculosis patients (OR = 0.97; 95% CI: 0.71, 1.32).ConclusionOne-third of tuberculosis patients are co-infected with one or more intestinal parasites, and they are more likely to be infected with intestinal helminths and multiple intestinal parasitic infections compared to TB free individuals. We recommend routine screening of tuberculosis patients for intestinal parasites. The effect of mass deworming on tuberculosis incidence would be important to be considered in future researches.Trial registrationRegistered on PROSPERO with reference number ID: CRD42019135350 .

Project description:BackgroundDelays in tuberculosis (TB) diagnosis and treatment is a major barrier to effective management of the disease. Determining the factors associated with patient and provider delay of TB diagnosis and treatment in Asia may contribute to TB prevention and control.MethodsWe searched the PubMed, EMBASE and Web of Science for studies that assessed factors associated with delays in care-seeking, diagnosis, or at the beginning of treatment, which were published from January 1992 to September 2014. Two reviewers independently identified studies that were related to our meta-analysis and extracted data from each study. Independent variables were categorized in separate tables for patient and provider delays.ResultsAmong 45 eligible studies, 40 studies assessed patient delay whereas 30 assessed provider delay. Cross-sectional surveys were used in all but two articles, which included 17 countries and regions. Socio-demographic characteristics, TB-related symptoms and medical examination, and conditions of seeking medical care in TB patients were frequently reported. Male patients and long travel time/distance to the first healthcare provider led to both shorter patient delays [odds ratio (OR) (95% confidence intervals, CI) = 0.85 (0.78, 0.92); 1.39 (1.08, 1.78)] and shorter provider delays [OR (95%CI) = 0.96 (0.93, 1.00); 1.68 (1.12, 2.51)]. Unemployment, low income, hemoptysis, and positive sputum smears were consistently associated with patient delay [ORs (95%CI) = 1.18 (1.07, 1.30), 1.23 (1.02, 1.49), 0.64 (0.40, 1.00), 1.77 (1.07, 2.94), respectively]. Additionally, consultation at a public hospital was associated with provider delay [OR (95%CI) = 0.43 (0.20, 0.91)].ConclusionsWe propose that the major opportunities to reduce delays involve enabling socio-demographic factors and medical conditions. Male, unemployed, rural residence, low income, hemoptysis, positive sputum smear, and long travel time/distance significantly correlated with patient delay. Male, long travel time/distance and consultation at a public hospital were related to provider delay.

Project description:BackgroundHealth seeking behavior is one of the challenges affecting tuberculosis (TB) control program because of its high risk to prolonged diseases transmission and poor treatment outcome. Although there are few primary studies that reported diversified magnitudes of health seeking behavior among presumptive TB patients in Ethiopia, there is no review study that attempted to summarize the available evidence. Thus, this review was aimed to estimate the proportion of health care seeking behavior from health facility and to summarize the reasons why individuals with presumptive TB are not seeking health care in Ethiopia.MethodA systematic review and meta-analysis study was conducted on primary studies that reported proportion of health seeking behavior among presumptive TB patients. Electronic databases: PubMed, Google Scholar and Science Direct were searched to retrieve studies published in English language from Ethiopia without restricting publication year. In addition, bibliographies of included studies were also screened to retrieve potential studies. The keywords "health seeking", "health seeking behavior", "TB suspects" and "presumptive TB" were used both in Medical Subject Heading (MeSH) and free text. Random effects meta-analysis model was used to estimate the pooled proportions of health care seeking and not seeking behaviors. Stata version 14 was used for data analysis.ResultFive studies which involved 3230 patients with presumptive TB were included into this review. The pooled estimated proportion of health care seeking behavior among presumptive TB patients from health facilities was 65% (95% CI, 54-76%), while the pooled proportion of not seeking health care from any sources was 17% (95% CI;6-27%). In addition, 18% (95% CI; 5-30%) of presumptive TB patients were seeking health care from inappropriate sources. Being female, younger age, low income status, absence of previous TB treatment history, low education status were the risk factors that associated with low health care seeking behavior.ConclusionConsiderable proportion of patients with presumptive TB were not seeking health care from health facilities or seeks care from inappropriate sources in Ethiopia. Implementing efforts that could improve health care seeking behavior is vital to prevent prolonged disease transmission through immediate treatment commencement.

Dataset Information

Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis.

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Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis.

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