Delay for Treatment and Associated Factors among Tuberculosis Patients in Jimma Town, Ethiopia

Background: Delay in Tuberculosis (TB) case detection and treatment may worsen the prognosis of the disease and spread of infection. The detection of a TB case in the country is through whereby people with symptoms are expected to go to health facilities for further investigation. Therefore, it is important to determine the factors responsible for the delay in seeking care in order to develop strategies to address them. Objectives: The objective of this study is to assess socio-cultural factors associated with patient delay in seeking care among tuberculosis patients attending TB clinics of Jimma University Specialized Hospital, Jimma Health Center and Shenen Gibe Hospital. Methods: A cross-sectional study was conducted from February 9 to 20/2015 involving 64, 27 and 14 TB patients from Jimma University Specialized Hospital, Jimma Health Center and Shenen Gibe Hospital TB clinics respectively. A face to face interview of selected TB patients was carried out at each TB clinic. The data were analyzed by the Statistical Package for Social Science (SPSS) version 16. Results were presented in frequencies, percentages and finally, the Chi-square test was applied to show the association between patient delay and associated factors. Results: Out of 105 participants, 64 (60.95%) of them were males and 41 (39.05%) were females. The average age of the respondents was 40 years; ranging from 15 to 65 years old. The study revealed that more than half of the patients (58.09%) delayed seeking care. The mean patient delay was 91 days with a range of 2 to 180 days. Older (above 45 years), farmers and patients with no formal education were significantly at an elevated risk to delay in seeking for health care. (P. value <0.05). Conclusion: Factors associated with a delay in seeking health care for more than 21 days after development of symptoms were age, education level, current occupation, and place of first resort and perceived severity of the disease. Raghavendra Yarlagadda, Temesgen Mulugeta*, Fanta Gashe, Ramanjireddy Tatiparthi 1. School of pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia. Submission: 22 October 2018 Accepted: 28 October 2018 Published: 30 November 2018 www.ijppr. humanjournals.com Citation: Temesgen Mulugeta et al. Ijppr.Human, 2018; Vol. 13 (4): 1-18. 2 INTRODUCTION Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis (MTB). It typically affects the lungs (pulmonary TB) but can affect other parts of the body as well (extrapulmonary TB). The disease is spread via droplet infection when people with pulmonary TB expel the bacilli while coughing, sneezing, talking, etc. Without treatment, mortality rates are high. Treatment using combinations of anti-TB drugs, developed in the 1940s and 1950s, can dramatically reduce mortality rates [1]. Tuberculosis (TB) is a major public health burden throughout the world. Almost one-third of the world population (about 2 billion) is infected with Mycobacterium tuberculosis and during the past decade, even industrialized countries have faced a resurgence of tuberculosis. About 95% of TB cases and 98% of deaths due to TB occur in developing countries [2]. Currently, TB is the leading cause of mortality among infectious diseases worldwide. Globally, TB remains the second leading cause of death from infectious diseases (after HIV/AIDS). Although progress has been made in global tuberculosis (TB) control, the disease remains one of the most intractable health challenges in lowand middle-income countries [1]. Knowledge plays an important role in determining the behavior and practices of individuals. Limited knowledge about signs and symptoms of TB, poor health-seeking behavior, and poor diagnosis and disease management in health facilities result in delays in TB diagnosis and treatment, which in turn, increase the risk of TB transmission and the development of MDRTB [12]. Therefore awareness regarding the TB disease is essential to molding the attitude or behavior of the patients towards the disease. Statement of problem According to the WHO Global TB report 2012, Ethiopia ranks 13th in the list of 22 high burden countries (HBCs) and 4th in Africa, with an estimated prevalence of all forms of TB in 200 per 100,000 populations. The diagnostic delay has been found to be a major obstacle in the control of TB especially in low-income countries [9, 8]. Literatures showed that many TB cases remain undiagnosed and untreated in many countries with a high incidence of TB that increases the risk of TB transmission in the community [2-5]. Studies on different parts of the world showed that different factors are associated with patient delay. Studies done in African countries mentioned that residence was an important predictor www.ijppr. humanjournals.com Citation: Temesgen Mulugeta et al. Ijppr.Human, 2018; Vol. 13 (4): 1-18. 3 of patient delay in initiating treatment [6, 7]. Similarly, in Asia and African countries being female was mentioned as a factor for predicting patient delay [6, 7]. The significance of the study Early diagnosis and treatment of Tuberculosis is crucial for the reduction of infection rate and improving outcome of the treatment. Despite efforts made through media to sensitize community warning symptoms of TB, still, there is a significant delay in healthcare seeking among TB patients. Credible evidence on predictors of patient delay could be important information to look for a new strategy to curb the death and spread of TB. Therefore, this study aims to investigate the extent of patient delay and its influencing factors among tuberculosis patients in Jimma town and its surroundings. Moreover, the data from this study has identified barriers for the delay in care seeking to strengthen the strategies for prevention and treatment of TB patients. MATERIALS AND METHODS Study area and period This study was conducted at Jimma University Specialized Hospital (JUSH), Jimma Health Center (JHC) and Shenen Gibe Hospital (SGH) tuberculosis DOTS clinics which were located in same, Jimma town from February 9 to 20/2015. Jimma town is found in Oromia region, southwest Ethiopia, 350km southwest from the capital of the country, Addis Ababa and at an altitude of 1780m above sea level.