Factors associated with treatment delay among newly diagnosed tuberculosis patients in Dessie city and surroundings, Northern Central Ethiopia: a cross-sectional study.

BACKGROUND: Delayed treatment of tuberculosis (TB) cases increases the risk of death and rate of infection in the community. Early diagnosis and initiation of treatment is essential for effective TB control. The aim of this study was to assess length of delays and analyze predictors of treatment delay of newly diagnosed TB patients. METHODS: A cross-sectional study was conducted in Dessie city and surroundings from April1, 2016 to January 30, 2017. Fifteen health facilities of study area were selected randomly and 382 adult TB patients were included consecutively. Data were collected using a questionnaire and analyzed using SPSS version 20.0. Delay was analyzed at three levels (patient, health system and total) using median as cut-off. Logistic regression analysis was performed to investigate predictors of delays. A p-value of ≤0.05 at multivariate analysis was considered statistically significant. RESULTS: The median total, patients' and health system's delay was 36 [interquartile range (IQR): 24, 64], 30 (IQR: 15, 60) and 6 (IQR: 4, 8) days, respectively. About 41 and 47% of patients had prolonged patients' and total delay, respectively. Practicing self-medication [adjusted odds ratio (AOR): 3.0; 95% CI: 1.3-5.6], having more than three family member in the household (AOR: 1.6; 95% CI: 1.02-2.50), older age (≥55 years) (AOR: 2.7; 95% CI: 1.27-5.83), being smear negative pulmonary tuberculosis (AOR: 2.3; 95% CI: 1.25-4.21) and extrapulmonary tuberculosis (AOR: 2.3; 95% CI: 1.28-4.07) were independent predictors of patients' delay. Initial visit of general practitioners (AOR: 2.57; 95% CI: 1.43-4.63) and more than one health care visit (AOR: 2.12; 95% CI: 1.30-3.46) were independent predictors of health system's delay. However, patients' delay was shorter among widowed/divorced patients (AOR: 0.3; 95% CI: 0.1-0.8). Lower level of education [illiterate (AOR: 0.42; 95% CI: 0.20-0.92), grade 1-8 (AOR: 0.38; 95% CI: 0.18-0.81)] and diagnosis of TB using a chest X-ray (AOR, 0.32; 95% CI, 0.16-0.68) significantly reduce health system's delay. CONCLUSION: About half of TB patients delayed beyond 36 days before starting treatment, and the late patient health seeking behavior was the major contributor of total delay. Development and implementation of strategies aimed at addressing identified factors should be recognized in order to reduce TB treatment delay. Further well designed research is needed to explore additional risk factors of delayed treatment.

Patients' and health system's delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study.

BACKGROUND: Tuberculosis (TB) is a major public health concern in the developing world. Early diagnosis and prompt initiation of treatment is essential for effective TB control. The aim of this study was to determine the length and analyze associated factors of patients' and health system's delays in the diagnosis and treatment of new pulmonary TB (PTB) patients. METHODS: A cross-sectional study was conducted in 30 randomly selected public health facilities in West Gojjam Zone, Amhara Region, Ethiopia. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study. Patients' delay (the time period from onset of TB symptoms to first presentation to a formal health provider) and health system's delay (the time period from first presentation to a formal health provider to first start of TB treatment) were measured. Median patients' and health system's delays were calculated. Mixed effect logistic regression was used to analyze predictors of patients' and health system's delays. RESULTS: Seven hundred six patients were enrolled in the study. The median patients' delay was 18 days (interquartile range [IQR]: 8-34 days) and the median health system's delay was 22 days (IQR: 4-88 days). Poor knowledge of TB (adjusted odds ratio [AOR], 2.33; 95 % confidence interval [CI], 1.34-4.05), first visit to non-formal health provider (AOR, 47.56; 95 % CI, 26.31-85.99), self-treatment (AOR, 10.11; 95 % CI, 4.53-22.56) and patients' age (≥45 years) (AOR, 2.99; 95 % CI, 1.14-7.81) were independent predictors of patients' delay. Smear-negative TB (AOR, 1.88; 95 % CI, 1.32-2.68) and first visit to public health centers (AOR, 2.22; 95 % CI, 1.52-3.25) and health posts (AOR, 5.86; 95 % CI, 1.40-24.39) were found to be independent predictors of health system's delay. CONCLUSIONS: The health system's delay in this study was long and contributed more than 50 % of the total delay. Better TB diagnostic tools to complement sputum smear microscopy are needed to early diagnose PTB cases at peripheral health facilities. In addition, due emphasis should be given to increase public awareness about symptoms and consequences of TB disease.

Celiac disease diagnosis still significantly delayed - Doctor's but not patients' delay responsive for the increased total delay in women.

BACKGROUND: There is insufficient data on diagnostic delay and associated factors in celiac disease (CeD) as well as on its potential impact on the course of disease. METHODS: Specifically taking its two components - patients' and doctors' delay - into account, we performed a large systematic patient survey study among unselected CeD patients in Switzerland. RESULTS: We found a mean/median total diagnostic delay of 87/24 months (IQR 5-96), with a range from 0 up to 780 months and roughly equal fractions of patients' and doctors' delay. Both mean/median total (93.1/24 vs. 60.2/12, p<0.001) and doctors' (41.8/3 vs. 23.9/2, p<0.001) diagnostic delay were significantly higher in female vs. male patients, whereas patients' delay was similar, regardless of preceding irritable bowel syndrome diagnosis. Patients with a diagnostic delay shorter than 2 years were significantly less often in need of steroids and/or immunosuppressants, substitution for any nutritional deficiency but more often free of symptoms 6 and 12 months after diagnosis. CONCLUSIONS: There is a substantial diagnostic delay in CeD, which is associated with a worse clinical outcome and significantly longer in female patients. This increased diagnostic delay in women is due to doctors' but not patients' delay and cannot be explained by antecedent IBS prior to establishing the CeD diagnosis.

Delay in the diagnosis and treatment of oral cancer.

STATEMENT OF PROBLEM: Oral and pharyngeal cancer is one of the most mortal cancers; however, its quick diagnosis and referral is a crucial factor in enhancing the survival rate of the patients. PURPOSE: The aim of this study was to inspect the referral conditions and the reasons for the delay in curing the patients referred to the educational hospitals in Tehran. MATERIALS AND METHOD: In this retrospective -descriptive study, two hundred and fifty six files related to the oral and pharyngeal cancer were inspected. The documents were obtained from 5 educational hospitals specialized in the field of cancers. Eventually data related to the time difference between the first time of attending to lesion and diagnosing the cancer as patient's delay and until the curing as professional's delay were recorded. RESULTS: The majority of cancers were squamous cell carcinoma (SCC). The patient's delay was recorded in 110 files among the whole files. The mean of the time between the patients' first notice of the problem and the time visiting a primary care clinician was 270 days (range, 0-2520 days). The mean of the time from when the patient visited a primary- care clinician to the starting time of definitive treatment was 90 days (range, 0-270 days). CONCLUSION: In this study, like other studies, SCC was the most common occurring cancer. Delays related to the patients were more than those related to the professionals. And at last, accuracy in recording the files and training the patients were recognized to be the most imperative factors to continue the treatment successfully.