Factors Associated with Health-care Service Delay in Diagnosis among Tuberculosis Patients in National Tuberculosis and Leprosy Training Centre in Zaria-Nigeria

Download Article

DOI: 10.21522/TIJPH.2013.06.04.Art002

Authors : Adedamola Amos Ogundeji, I Ahmadu, J Awotoye, J Ogwu, S Laraban, J Ajobiewe, O.M Akinsola

Abstract:

Background: Any delay in diagnosis and consequently treatment of TB patients not only increases the infectivity of the disease in the community, but may lead to more advance disease state, which may result in more complications and expose patients to higher risk of death. Objectives To assess delays in diagnosing new TB patients and the factors associated with these delays in NTBLTC Zaria, Nigeria. Methods: The study population was TB patients attending the NTBLTC, Zaria. Analysis of contingency tables was done and Chi-square statistics were used to test for association between variables and level of significance. Logistic regression was used to calculate the odd ratio. Results: Age, marital status, economic status, sex, education, and alcohol consumption were significantly (P<0.05) associated with patient delays while smoking and CD4 count were statistically not significant with patient delays. Female (OR=1.046; 1.04-2.17), literacy (OR=1.02; 0.29-1.98) and single (OR=1.00; 0.14-4.67) were the major determinants that influence extended patient delay. Age, economic status, education, smoking and alcohol consumption were significantly (P<0.05) associated with health system delays while sex, marital status and CD4 count were statistically not significant with health system delays. Conclusion: Factors associated with delay in seeking health care for more than 30 days included age, sex, marital status, economic status, education, smoking and alcohol intake while for patient delay includes age, sex, marital status, economic status, education and alcohol intake. This factor should be taken into consideration for policy planning to help the containment of the spread of the disease.

Keywords: Health care service delay, cross-sectional, odd ratio, tuberculosis, Logistic regression, patient delay.

References:

[1].     Atre SR et al. (2004). Cultural concepts of tuberculosis and gender among the general population without tuberculosis in rural Maharashtra, India. Trop Med Int Health, 9(11):1228–38.

[2].     Fazlul K, Akramul I, Chowdhury A, Johansson E, Diwan C. (2007). Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy Plan, 329–34.

[3].     Federal Ministry of Health, Department of Public Health. National tuberculosis and leprosy control programme: workers manual. 5. Abuja, Nigeria: Federal Ministry of Health; 2010.

[4].     Horwitz, L.I., Green, J. & Bradley, E. H., (2010). US Emergency Department Performance on Wait Time and Length of Visit. Annals of Emergency Medicine, 55(2), pp.133– 141.

[5].     IAR. (2013). Meteorological Service Unit, Ahmadu Bello University, Zaria.

[6].     Lawn S. D, Afful B, Acheampong J. W. (1998). Pulmonary tuberculosis: diagnostic delay in Ghanaian adults. Int J Tuberc Lung Dis, 2(8):635–40.

[7].     Maluwa VM1, Andre J, Ndebele P, Chilemba E. (2012). Moral distress in nursing practice in Malawi. Nurs Ethics. Mar; 19 (2):196-207. doi: 10.1177/0969733011414968.

[8].     Mardiah, F. P. & Basri, M.H., (2013). The Analysis of Appointment System to Reduce Outpatient Waiting Time at Indonesia’s Public Hospital: Human Resource Management Research 3(1): 27-33, doi:10.5923/j.hrmr.20130301.06

[9].     Musinguzi, C., (2015). Patient waiting time and associated factors at the Assessment Center, General out-patient Department Mulago Hospital Uganda. (October).

[10]. Ngadaya S. E, Mfinanga S. G, Wandwalo R. E, Morkve O. (2009): Delay in Tuberculosis case detection in Pwani region, Tanzania, a cross-sectional study. BMC Health Services Research. 9:196 https://doi.org/10.1186/1472-6963-9-196

[11]. Oche, M. & Adamu, H. (2013). Determinants of patient waiting time in the general outpatient department of a tertiary health institution in north Western Nigeria.
Annals of medical and health sciences research, 3(4), pp.588–592

[12]. Odusanya O. O, Babafemi J. O. (2004). Patterns of delays amongst pulmonary tuberculosis patients in Lagos, Nigeria. BMC Public Health, 4:18.

[13]. Okotie, O.T., Patel, N. & Gonzalez, C. M., (2008). The effect of patient arrival time on overall wait time and utilization of physician and examination room resources in the outpatient urology clinic. Advances in urology, p.507436.

[14]. Umar, I., Oche, M. O., & Umar, A. S. (2011). Patient waiting time in a tertiary health institution in Northern Nigeria. Journal of Public Health and Epidemiology, 3(2), pp.78–82. Available at: http://www.academicjournals.org/jphe.

[15]. Storla, D. G., Yimer S, Bjune G. A. A. (2008). Systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health. I8:15.

[16]. Shuster, J.J. (1990). Handbook of Sample Size Guidelines for Clinical Trials, Boca Raton, FL: CRC Press

[17]. Wandera M. N., Onyango R., & Kakai R. (2014). Determinants of Clients’ Satisfaction with healthcare Services at Pumwani Maternity Hospital in Nairibi-Kenya. International Journal of Social & Behavioural Sciences. Vol. 2 (1), pp. 011 – 017.

[18]. Wanyenze RK1, Wagner G, Alamo S, Amanyire G, Ouma J, Kwarisima D, Sunday P, Wabwire-Mangen F, Kamya M. (2010) Evaluation of the efficiency of patient flow at three HIV clinics in Uganda. AIDS Patient Care STDS. 2010 Jul; 24 (7):441-6. doi: 10.1089/apc.2009.0328.

[19]. WHO. (2006). Diagnostic and treatment delay in tuberculosis. An in-depth analysis of the health-seeking behaviour of patients and health system response in seven countries of the eastern mediterranean region. Regional Officer for the Eastern mediterranean, Cairo, World Health Organization.

[20]. WHO. (2015). Tuberculosis Fact sheet N°104 Reviewed March 2015 [Internet]. 2015. Available from: http://www.who.int/mediacentre/factsheets/fs104/en.

[21]. Yeboah, E. & Thomas, M. (2009). A cost-effective way of reducing outpatient clinic waiting times: How we did it., 7(1), pp.6–9

[22]. Whyte, E. & Goodacre, S. (2016). Patient expectations of emergency hospital admission: a cross-sectional questionnaire survey. European journal of emergency medicine:
official journal of the European Society for Emergency Medicine, 23(3), pp.203– 207.