FACTORS ASSOCIATED WITH DELAY IN TUBERCULOSIS MANAGEMENT IN SARAWAK, MALAYSIA
Keywords:Tuberculosis, Patient delay, Diagnosis delay, Treatment delay, Tuberculosis management, Sarawak
Delay in Tuberculosis (TB) management is a public health concern that leads to unfavourable treatment outcomes. The delays could come from the patients or the health care facilities. This study aimed to determine TB management in terms of delays in diagnosis and treatment initiation among TB patients in Sarawak, Malaysia. This cross-sectional study was conducted among adult TB patients through face-to-face interviews using adapted and validated questionnaires. Seven hundred twenty-four patients were selected using a systematic random sampling method from 17 TB clinics in Sarawak. Data entry and analysis were done by IBM SPSS Version 22.0. The median duration of the patient, diagnostic and treatment delay was 1080 days, 61 days, and two days, respectively. The multivariate binary logistic regression analysis revealed that the university level of education (p<.05) and visiting healthcare facilities four times and above (p<.001) appeared to be statistically significantly associated with patient delay. In diagnostic delay, females, moderate family stigma (p<.01), and multiple visits to a healthcare facility (p<.001) were found to be significant factors. However, age 50-59 years, ethnicity, the primary and secondary level of education (p<.01), TB knowledge (p<.05), number of symptoms, the action was taken (p<.001), been advised (p<.01), and investigations during the first visit (p<.05) were significantly associated with treatment delay. Though the study did not depict the national scenarios of overall delays in TB management, the factors identified in this study would be policy options to reduce the delays in the initiation of future TB management.
Kanabus A. TB facts - Tests, drugs, statistics & lots more about TB disease. GHE. Available at: https://tbfacts.org/. Accessed 8 January 2022, 2022.
World Health Organization. Implementing the end TB strategy: the essentials: World Health Organization; 2015. 9241509937.
World Health Organization. Global Tuberculosis Report 2013: World Health Organization; 2013.
Ministry of Health Malaysia. Annual Report, Ministry of Health Malaysia 2017. Kuala Lumpur: Health Informatics Centre 2017.
Tsara V, Serasli E, Christaki P. Problems in diagnosis and treatment of tuberculosis infection. Hippokratia. 2009;13(1):20-22
World Health Organization. Systematic Screening for Active Tuberculosis: Principles and recommendations Geneva, Switzerland: World Health Organization,; 2013. WHO/HTM/TB/2013.04
Vree M, Huong NT, Duong BD, et al. High mortality during tuberculosis treatment does not indicate long diagnostic delays in Vietnam: a cohort study. BMC Public Health. Aug 16 2007;7:210.https://doi.org/10.1186/1471-2458-7-210
Awoke N, Dulo B, Wudneh F. Total Delay in Treatment of Tuberculosis and Associated Factors among New Pulmonary TB Patients in Selected Health Facilities of Gedeo Zone, Southern Ethiopia, 2017/18. Interdiscip Perspect Infect Dis. 2019;2019:2154240.https://doi.org/10.1155/2019/2154240
Bassili A, Seita A, Baghdadi S, et al. Diagnostic and Treatment Delay in Tuberculosis in 7 Countries of the Eastern Mediterranean Region. Infectious Diseases in Clinical Practice. 2008;16(1)
Buregyeya E, Criel B, Nuwaha F, Colebunders R. Delays in diagnosis and treatment of pulmonary tuberculosis in Wakiso and Mukono districts, Uganda. BMC Public Health. Jun 11 2014;14:586.https://doi.org/10.1186/1471-2458-14-586
Hargreaves JR, Boccia D, Evans CA, Adato M, Petticrew M, Porter JDH. The social determinants of tuberculosis: from evidence to action. American journal of public health. 2011;101(4):654-662.https://doi.org/10.2105/AJPH.2010.199505
Islam MZ, Efa SS, Farjana S. Patient factors related to pre-treatment delay of pulmonary tuberculosis: A retrospective cohort study in Bangladesh. Indian J Tuberc. Oct 2020;67(4):472-478.https://doi.org/10.1016/j.ijtb.2020.07.009
Mathew AS, Takalkar AM. Living with Tuberculosis: The Myths and the Stigma from the Indian Perspective. Clinical Infectious Diseases. 2007;45(9):1247-1247.https://doi.org/10.1086/522312
Dangisso MH, Datiko DG, Lindtjørn B. Accessibility to tuberculosis control services and tuberculosis programme performance in southern Ethiopia. Global health action. 2015;8:29443-29443.https://doi.org/10.3402/gha.v8.29443
Margineanu I, Louka C, Vincenti-Gonzalez M, et al. Patients and Medical Staff Attitudes Toward the Future Inclusion of eHealth in Tuberculosis Management: Perspectives From Six Countries Evaluated using a Qualitative Framework. JMIR Mhealth Uhealth. Nov 2 2020;8(11):e18156.https://doi.org/10.2196/18156
Kiwuwa MS, Charles K, Harriet MK. Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: a cross-sectional study. BMC public health. 2005;5:122-122.https://doi.org/10.1186/1471-2458-5-122
Sawadogo B, Tint KS, Tshimanga M, Kuonza L, Ouedraogo L. Risk factors for tuberculosis treatment failure among pulmonary tuberculosis patients in four health regions of Burkina Faso, 2009: case control study. The Pan African medical journal. 2015;21:152-152.https://doi.org/10.11604/pamj.2015.21.152.4827
Rundi C, Fielding K, Godfrey-Faussett P, Rodrigues LC, Mangtani P. Delays in seeking treatment for symptomatic tuberculosis in Sabah, East Malaysia: factors for patient delay. Int J Tuberc Lung Dis. Sep 2011;15(9):1231-1238, i.https://doi.org/10.5588/ijtld.10.0585
Sharkawi HM. Assessment of Tuberculosis Control Program in Sarawak. Kota Samarahan, Universiti Malaysia Sarawak; 2016.
Ngadan DP. Delay in Diagnosis Among Sputum Smear Positive Tuberculosis Patients in Kuching, Sarawak, Universiti Malaysia Sarawak; 2012.
Quattrocchi A, Barchitta M, Nobile CGA, et al. Determinants of patient and health system delay among Italian and foreign-born patients with pulmonary tuberculosis: a multicentre cross-sectional study. BMJ Open. Aug 5 2018;8(8):e019673.https://doi.org/10.1136/bmjopen-2017-019673
Usman A, Zubair UB, Ambreen A, Yousaf H, Kaleem F, KHALİL KF. Delay in diagnosis of Pulmonary Tuberculosis: Study of factors related to patients and health care system. Journal of Microbiology and Infectious Diseases. 2017;7(03):119-124.https://doi.org/10.5799/jmid.367424
Choudhari M, Jha N, Yadav DK, Chaudhary D. Factors associated with patient delay in diagnosis of pulmonary tuberculosis in a district. J Nepal Health Res Counc. Sep 2012;10(22):234-238
Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health. Jan 14 2008;8:15.https://doi.org/10.1186/1471-2458-8-15
Almeida CP, Skupien EC, Silva DR. Health care seeking behavior and patient delay in tuberculosis diagnosis. Cad Saude Publica. Feb 2015;31(2):321-330.https://doi.org/10.1590/0102-311x00195413
Chang CT, Esterman A. Diagnostic delay among pulmonary tuberculosis patients in Sarawak, Malaysia: a cross-sectional study. Rural Remote Health. Apr-Jun 2007;7(2):667
Patki GA, Raut AV, Datar S. Delay in initiation of treatment of tuberculosis: A cross-sectional study from rural Wardha. CHRISMED Journal of Health and Research. 2019;6(1):12
IBM SPSS Statistics for Windows [computer program]. Version 27. Armonk, New York, USA: IBM SPSS; 2020.
Tabachnick BG, Fidell LS. Using multivariate statistics. 7th Edition ed. United States: Pearson Education, Inc; 2019.
Abdullah N, Borhanuddin B, Patah AEA, et al. Utilization of Complementary and Alternative Medicine in Multiethnic Population: The Malaysian Cohort Study. J Evid Based Integr Med. Jan-Dec 2018;23:2515690x18765945.https://doi.org/10.1177/2515690x18765945
Tattevin P, Che D, Fraisse P, et al. Factors associated with patient and health care system delay in the diagnosis of tuberculosis in France. The international journal of tuberculosis and lung disease. 2012;16(4):510-515
Farah MG, Rygh JH, Steen TW, Selmer R, Heldal E, Bjune G. Patient and health care system delays in the start of tuberculosis treatment in Norway. BMC Infect Dis. Feb 24 2006;6:33.https://doi.org/10.1186/1471-2334-6-33
World Health Organization. Diagnostic and treatment delay in tuberculosis 2006.
Yirgu R, Lemessa F, Hirpa S, Alemayehu A, Klinkenberg E. Determinants of delayed care seeking for TB suggestive symptoms in Seru district, Oromiya region, Ethiopia: a community based unmatched case-control study. BMC Infectious Diseases. 2017/04/20 2017;17(1):292.https://doi.org/10.1186/s12879-017-2407-8
Karim F, Islam MA, Chowdhury AM, Johansson E, Diwan VK. Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy Plan. Sep 2007;22(5):329-334.https://doi.org/10.1093/heapol/czm026
Abdullah NH, Naing NN, Abdullah MR, et al. Factors Influencing Patient Delay in Seeking Treatment among Smear Positive Tuberculosis Patients in Kelantan, Malaysia. International Medical Journal. 2011;18(4)
Getahun G, Erchafo B, Gebretsadik LA, Chaka M. Patient Delay and Associated Factors Among Pulmonary Tuberculosis Patients at Hadiya Zone Public Health Facilities in South Ethiopia, 2017. European Journal of Clinical and Biomedical Sciences. 2018;4(4):55-62
Fekadu G, Melese A, Bayisa G. Assessment of Knowledge, Attitude and Practice of Health Care Providers towards the Prevention and Control of Multi Drug Resistant Tuberculosis at Nekemte Referral Hospital, Western Ethiopia. Journal of Medical Systems. 01/30 2019;9:243-255.https://doi.org/10.15520/ijmhs.v9i1.2418
Htun YM, Khaing TMM, Yin Y, et al. Delay in diagnosis and treatment among adult multidrug-resistant tuberculosis patients in Yangon Regional Tuberculosis Center, Myanmar: a cross-sectional study. BMC Health Serv Res. Nov 20 2018;18(1):878.https://doi.org/10.1186/s12913-018-3715-4
Biya O, Gidado S, Abraham A, et al. Knowledge, care-seeking behavior, and factors associated with patient delay among newly-diagnosed pulmonary tuberculosis patients, Federal Capital Territory, Nigeria, 2010. Pan Afr Med J. 2014;18 Suppl 1(Suppl 1):6.https://doi.org/10.11694/pamj.supp.2014.18.1.4166
Zhou C, Chu J, Geng H, Wang X, Xu L. Pulmonary tuberculosis among migrants in Shandong, China: factors associated with treatment delay. BMJ Open. Dec 22 2014;4(12):e005805.https://doi.org/10.1136/bmjopen-2014-005805