Assessment of Related Factors on Delay in Diagnosis of Patients with Smear-Positive Pulmonary Tuberculosis

Document Type : Original Article (s)

Authors

1 Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

2 Assistant Professor, Health Sciences Research Center AND Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

3 Deputy for Health, Hamadan University of Medical Sciences, Hamadan, Iran

4 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan AND PhD Student, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

5 Researcher, Minimally Invasive Surgery Research Center, Iran University of Medical Sciences AND PhD Student, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Approximately, one third of the world population is infected with tuberculosis (TB) germs and is put at risk of tuberculosis. Pulmonary tuberculosis accounts for more than 80 percent of cases, mostly in adults with positive sputum smear. The mortality and morbidity of the disease are associated with delay in diagnosis. Delay in diagnosis can be related to the patients or the health care system.Methods: In this historical cohort study, all the patients with smear-positive pulmonary tuberculosis in Hamadan province from 21 March 2006 to 20 March 2012 were studied. Data on demographic characteristics, and clinical and treatment status of patients were extracted using patient registry software entitled TB Register. To determine the relationship between variables and the bacillus load, chi-square test was used. The logistic regression model was used to examine the co-effects of both variables on bacillus load of the patients at the time of the diagnosis. Data were analyzed using Stata11 software.Findings: From 440 patients with smear-positive pulmonary tuberculosis, 51% (221 patients) were men and 49% (219 patients) were women. 57% (251 people) were living in urban and others in rural areas. The grade of sputum smear at the time of diagnosis was associated with area of residence, age group, and gender, that all were statistically significant. Delay in diagnosis among women, was approximately 0.55 of men and those in urban areas were 67% higher than in rural areas, which were both statistically significant.Conclusion: Individual factors play important role in delayed diagnosis, regarding that men are diagnosed later than the women. Screening programs in the workplace are recommended. Sensitization of private physicians would be effective in early identification of patients in urban areas.

Keywords

References

  1. Steingart KR, Henry M, Ng V, Hopewell PC, Ramsay A, Cunningham J, et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis 2006; 6(9): 570-81.
  2. World Health Organization. Global tuberculosis control. Geneva, Switzerland: WHO; 2009.
  3. World Health Organization. Treatment of tuberculosis: guidelines for national programmes. Geneva, Switzerland: WHO; 2006.
  4. Centers for Disease Control and Prevention. Handbook of tuberculosis. 1st ed. Tehran, Iran: Seda Publications; 2002.
  5. World Health Organization. Global tuberculosis control: surveillance, planning, financing. Geneva, Switzerland: WHO; 2003.
  6. World Health Organization. Tuberculosis case-finding and chemotherapy: questions and answers. Geneva, Switzerland: WHO; 1979.
  7. World Health Organization. Groups at risk: WHO report on the tuberculosis epidemic. Geneva, Switzerland: WHO; 1996.
  8. Styblo K. Epidemiology of tuberculosis. The Hague, Netherlands: Royal Netherlands Tuberculosis Association; 1991.
  9. Wondimu T, K W/Michael K, Kassahun W, Getachew S. Delay in initiating tuberculosis treatment and factors associated among pulmonary tuberculosis patients in East Wollega, Western Ethiopia. Ethiopian Journal of Health Development 2007; 21(2): 148-57.
  10. Goletti D, Weissman D, Jackson RW, Graham NM, Vlahov D, Klein RS, et al. Effect of Mycobacterium tuberculosis on HIV replication. Role of immune activation. J Immunol 1996; 157(3): 1271-8.
  11. Ayuo PO, Diero LO, Owino-Ong'or WD, Mwangi AW. Causes of delay in diagnosis of pulmonary tuberculosis in patients attending a referral hospital in Western Kenya. East Afr Med J 2008; 85(6): 263-8.
  12. Demissie M, Lindtjorn B, Berhane Y. Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health 2002; 2: 23.
  13. Pronyk RM, Makhubele MB, Hargreaves JR, Tollman SM, Hausler HP. Assessing health seeking behaviour among tuberculosis patients in rural South Africa. Int J Tuberc Lung Dis 2001; 5(7): 619-27.
  14. Karim F, Islam MA, Chowdhury AM, Johansson E, Diwan VK. Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy Plan 2007; 22(5): 329-34.
  15. Masjedi MR, Gharaghvandi A, Hadian M, Valayati AA. Patient delay and treatment delay in patient with pulmonary tuberculosis. Pajouhesh Dar Pezeshki 1995; 19(3-4): 70-7. [In Persian].
  16. World Health Organization. Diagnostic and treatment delay in tuberculosis. Nasr City, Cairo: Eastern Mediterranean regional office; 2006.
Journal of Isfahan Medical School
Volume 33, Issue 332 - Serial Number 332
March and April 2015
Pages 596-603

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History

  • Receive Date: 15 November 2014
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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