Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam,Tanzania  

作　　者：Khadija Said Jerry Hella Grace Mhalu Mary Chiryankubi Edward Masika Thomas Maroa Francis Mhimbira Neema Kapalata Lukas Fenner 

机构地区：[1]Ifakara Health Institute,Bagamoyo Research and Training Centre(BRTC),P O Box 74,Bagamoyo,Tanzania [2]Swiss Tropical and Public Health Institute,Socinstrasse 57,4002 Basel,Switzerland [3]University of Basel,Petersplatz 1,4003 Basel,Switzerland [4]National Tuberculosis and Leprosy Programme,Dar es Salaam,Tanzania [5]Institute of Social and Preventive Medicine,University of Bern,Bern,Switzerland

出　　处：《Infectious Diseases of Poverty》2017年第1期548-557,共10页贫困所致传染病（英文）

基　　金：This work was supported by funding from the Rudolf Geigy Foundation(Basel,Switzerland).KS is a beneficiary of the Swiss Excellence Scholarship(ESKAS);The funder was not involved in study design,data collection,interpretation of data or in writing the manuscript.

摘　　要：Background:Tanzania 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.Methods:We 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.Results:We 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).Conclusions:TB 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

关 键 词：Tanzania TUBERCULOSIS Diagnostic delay Health-seeking Geographic information system PHARMACY TRANSMISSION 

分 类 号：R73[医药卫生—肿瘤]