RESUMEN
Introduction: Fear of COVID-19 makes tuberculosis (TB) patients seek health care after complications of the case. This can be the reason for serious illness, increased length of infectiousness, poor treatment outcomes, and economic crisis for families and the health system. Despite this, no study has been conducted in Ethiopia and in other African countries with the factor "fear of COVID-19." Identified preventable factor and other covariates are used to reduce the healthcare-seeking delay. Objective: This study assessed the association of fear of COVID-19 with healthcare-seeking delay among TB patients in Ilu Ababor Zone health facilities, south-western Ethiopia. Methods and materials: A health institution-based cross-sectional study was conducted among TB patients from October 15, 2020, to March 1, 2021. Using a systematic sampling method, 403 TB patients were selected for face-to-face interviews. The association of fear of getting COVID-19 with healthcare-seeking delay was assessed by a chi-square test. Variables with a p-value <0.25 in the bi-variable binary logistic regression were entered into the multivariable binary logistic regression model. The level of statistical significance in multivariable binary logistic regression was declared at a p-value <0.05. Result: In this study, the proportion of patient healthcare-seeking delay was 46.7%. Chi-square test of the association of fear of COVID-19 with healthcare-seeking delay among TB patients showed a significant association (p-value = 0.042). After controlling for covariates, patients living in rural area (adjusted odds ratio (AOR) = 2.437, 95% confidence interval (CI): 1.385-4.286), patients with poor knowledge (AOR = 3.300, 95% CI: 1.792-6.078), earning monthly income <200 Ethiopian birr (ETB) (AOR = 3.912 95% CI: 1.951-7.841), traveling greater than 30 min (AOR = 2.127, 95% CI: 1.301-3.476), and fear of COVID-19 pandemic (AOR = 3.124, 95% CI: 1.029-9.479) were significantly associated with patient healthcare-seeking delay. Conclusion: The study found that healthcare-seeking delay among TB patients was substantial. Patient healthcare-seeking delay was significantly associated with fear of COVID-19.
RESUMEN
BACKGROUND: The main target of tuberculosis control and prevention is to detect incident cases as quickly as possible and also to prevent the occurrence of disease. It is also the responsibility of the health facility to screen the contacts, identifying children for prophylactic therapy. However, the target is difficult to meet due to issues within health facilities that cause health system diagnostic delays. Despite this, there is no information explored why health system diagnostic delays among tuberculosis patients. METHOD: A qualitative study was conducted by using different data collection methods and sources. Seventeen DOT providers, five laboratory professionals, six program managers, and seven Tuberculosis patients were interviewed. In addition, 22 governmental health facilities were observed for the availability of resources. Data obtained from the in-depth interviews was transcribed, coded, categorized, and thematized manually. RESULT: Health system Diagnosis delays reasons were related with sample collection procedures, poor competency of health professionals, in addition to absences or scarcity of health professionals, medical products, and basic infrastructure. We found 18 health facilities without skilled personnel in the OPD, 7 health facilities with a broken microscope, and almost all health facilities without a separate room for sputum examination. Furthermore, 12 (54.5%) and 14 (63.6%) health facilities lacked access to water and electric power, respectively. CONCLUSION: Many reasons for TB diagnosis delays have been identified in the study area. Poor competence of health workers and scarcity of resources were identified. Depending on the finding, we suggest strengthening the health workers' training. Concrete strategies need to be designed to retain professionals. Training on human resource planning and budget preparation is needed for front-line managers. Managers have to work on the maintenance of diagnostic tools and facilitate transportation. The rural health facilities need to use another alternative power source.