Determinants of Patient Delay in Diagnosis of Pulmonary Tuberculosis in Somali Pastoralist Setting of Ethiopia: A Matched Case-Control Study

Fentabil Getnet, Meaza Demissie, Alemayehu Worku, Tesfaye Gobena, Berhanu Seyoum, Rea Tschopp and Christopher T. Andersen
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Fentabil Getnet: Department of Public Health, Jigjiga University, Jigjiga 1020, Ethiopia
Meaza Demissie: Addis Continental Institute of Public Health, Addis Ababa 26751, Ethiopia
Alemayehu Worku: Addis Continental Institute of Public Health, Addis Ababa 26751, Ethiopia
Tesfaye Gobena: School of Public Health, Haramaya University, Harar 138, Ethiopia
Berhanu Seyoum: Armauer Hansen Research Institute, Addis Ababa 1005, Ethiopia
Rea Tschopp: Armauer Hansen Research Institute, Addis Ababa 1005, Ethiopia
Christopher T. Andersen: Harvard TH Chan School of Public Health, Harvard University, Boston, MA 02138, USA

IJERPH, 2019, vol. 16, issue 18, 1-12

Abstract: Background : Healthcare-seeking behavior is the basis to ensure early diagnosis and treatment of tuberculosis (TB) in settings where most cases are diagnosed upon self-presentation to health facilities. Yet, many patients seek delayed healthcare. Thus, we aimed to identify the determinants of patient delay in diagnosis of pulmonary TB in Somali pastoralist area, Ethiopia. Methods : A matched case-control study was conducted between December 2017 and October 2018. Cases were self-presented and newly diagnosed pulmonary TB patients aged ? 15 years who delayed > 30 days without healthcare provider consultation, and controls were patients with similar inclusion criteria but who consulted a healthcare provider within 30 days of illness; 216 cases sex-matched with 226 controls were interviewed using a pre-tested questionnaire. Hierarchical analysis was done using conditional logistic regression. Results : After multilevel analysis, pastoralism, rural residence, poor knowledge of TB symptoms and expectation of self-healing were individual-related determinants. Mild-disease and manifesting a single symptom were disease-related, and >1 h walking distance to nearest facility and care-seeking from traditional/religious healers were health system-related determinants of patient delay > 30 days [ p < 0.05]. Conclusion : Expansion of TB services, mobile screening services, and arming community figures to identify and link presumptive cases can be effective strategies to improve case detection in pastoral settings.

Keywords: patient delay; determinant; diagnosis; tuberculosis; pastoral; Ethiopia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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