Skip to main content
The Egyptian Journal of Bronchology
Download PDF
  • Original article
  • Open access
  • Published:

Delay in the diagnosis and management of tuberculosis among patients in the Suez Canal Area

Egyptian Journal of Bronchology volume 13, pages 523–530 (2019)Cite this article

Abstract

Background

Delayed diagnosis of tuberculosis (TB) can enhance the transmission of infection and worsen prognosis.

Aim

To identify the risk factors of delay in the management of TB cases for early management.

Patients and methods

A cross-sectional analytic study was performed to assess the proportion, duration of delay, and its determinants in the diagnosis and management of TB. To assess the risk factors of delay, the sample was dichotomized into ‘delay’ and ‘nondelay’ groups taking the median total delay in the diagnosis and management of TB as a cutoff point. The study included 183 TB patients, who were registered in TB records during the study period (first of January to end of June, 2017). Data were collected by an interview questionnaire.

Results

Nearly half of patients (49.20%) had unacceptable total delay in the diagnosis and management of TB. The median of total delay, patient delay, and health-care system delay were 65, 14, and 20 days, respectively. Significant risk factors of total delay in the diagnosis and management of TB were not consulting the health-care provider after onset of symptoms (P=0.002), visiting initially the health facility other than the chest hospital/TB clinics (P=0.019), not consulting a chest physician initially (P=0.043), negative sputum smear (P=0.001), more than two health visits before initial diagnosis (P<0.001), while low-degree TB stigma was protective (P=0.006).

Conclusion

Nearly half of patients had unacceptable total delay in the diagnosis and management of TB. The main determinants were seeking pharmacies instead of visiting health-care providers, not visiting initially chest hospital/TB clinics, not consulting a chest physician initially, negative sputum smear, and more than two health visits before initial diagnosis.

References

  1. World Health Organization (WHO). Global tuberculosis report 2017. http://www.who.int/tb/publications/globalreport/gtbr2017maintext.pdf?u%20a=1 published on 30 Oct 2017 as REPORT from World Health Organization printed in Switzerland WHO/HTM/TB/2017.23. Global Tuberculosis report 2017 ISBN978-92-4-156551-6 © World Health Organization 2017

  2. Eltayeb D. Factors associated with patient and health system delay in diagnosis and commencement of treatment for pulmonary tuberculosis in the Middle East and North Africa (MENA): systematic review (doctoral dissertation). Cape Town, South Africa: University of Cape Town, 2016.

    Google Scholar 

  3. Finnie RKC, Khoza LB, van den Borne B, Mabunda T, Abotchie P, Mullen P. Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub-Saharan African countries with high burdens of TB and HIV. Trop Med Int Heal 2011; 16:394–411.

    Article  Google Scholar 

  4. Leutscher P, Madsen G, Erlandsen M, Veirum J, Ladefoged K, Thomsen V, et al. Demographic and clinical characteristics in relation to patient and health system delays in a tuberculosis low-incidence country. Scand J Infect Dis 2012; 44:29–36.

    Article  Google Scholar 

  5. World Health Organization. Diagnostic and treatment delay in tuberculosis. WHO EMRO report2006. http://www.emro.who.int/dsaf/dsa710.pdf. [Accessed 6 March 2013].

  6. Yimer SA, Bjune GA, Holm-Hansen C. Time to first consultation, diagnosis and treatment of TB among patients attending a referral hospital in Northwest, Ethiopia. BMC Infect Dis 2014; 14:19.

    Article  Google Scholar 

  7. Negm MF, Ali TM, Elfadil SSA. Tuberculosis situation in Ismailia governorate (2002–2012) before and after direct observed therapy short course strategy (DOTS). Egypt J Chest Dis Tuberc 2016; 65:211–217.

    Article  Google Scholar 

  8. Sobh E, Kinawy SA, Abdelkarim YM, Arafa MA. The pattern of tuberculosis in Aswan Chest Hospital, Egypt. Int J Mycobacteriol 2016; 5:333–340.

    Article  Google Scholar 

  9. Central Agency for Public Mobilization and Statistics (CAPMAS). 2017. Available at: www.egyptindependent.com/egypt-population-smokers-capmas/ http://www.egypttoday.com/Article/1/6109/20-2-of-Egyptians-are-smokers-CAPMAS.

  10. World Health Organization(WHO). (2018). Factsheat. Available at: www.who.intnews-room/fact-sheets/detail/tuberculosis. https://www.egypttoday.com/Article/1/6109/20-2-of-Egyptians-are-smokers-CAPMAS. [Accessed 18 September 2018].

  11. Osei E, Akweongo P, Binka F. Factors associated with DELAY in diagnosis among tuberculosis patients in Hohoe Municipality, Ghana. BMC Public Health 2015; 15:721.

    Article  Google Scholar 

  12. Elhadidy S, El-bestar S, Kamel E, Shalabi N. Workplace pulmonary tuberculosis case detection in Mansoura City and neighborhood villages. Egpt J Bronchol 2018; 12:266–272.

    Google Scholar 

  13. Worldbank, 2018. https://data.worldbank.org/indicator/SH.TBS.CURE. ZSWorldbank2018. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. https://www.statista.com/statistics/377343/unemployment-rate-in-egypt/

  14. Takarinda KC, Harries AD, Nyathi B, Ngwenya M, Mutasa-Apollo T, Sandy C. Tuberculosis treatment delays and associated factors within the Zimbabwe national tuberculosis programme. BMC Public Health 2015; 15:29.

    Article  Google Scholar 

  15. Lusignani LS, Quaglio G, Alzori A, Nsuka A, Putoto G, Grainger R, et al. Factor associated with patients and healthcare system delay in diagnosis for tuberculosis in the province of Luanda, Angola. BMC Infect Dis 2013; 13:1–168.

    Article  Google Scholar 

  16. Kansiime C, Kiwuwa SM, Levi M, Asiimwe BB, Katamba A. Health service delay among pulmonary tuberculosis patients presenting to a National Referral Hospital, Kampala, Uganda: a cross sectional study. Pan Afr Med J 2013; 15:84.

    Article  Google Scholar 

  17. Mistry N, Rangan S, Dholakia Y, Lobo E, Shah S, Patil A. Durations and delays in care seeking, diagnosis and treatment initiation in uncomplicated pulmonary tuberculosis patients in Mumbai, India. PLoS ONE 2016; 11:152–287.

    Google Scholar 

  18. Adejumo OA, Daniel OJ, Otesanya AF, Adejumo EN. Determinants of health system delay at public and private directly observed treatment, short course facilities in Lagos State, Nigeria: a cross-sectional study. Int J Mycobacteriol 2016; 5:257–264.

    Article  Google Scholar 

  19. Deponti GN, Silva DR, Coelho AC, Muller AM, Dalcin Pde T. Delayed diagnosis and associated factors among new pulmonary tuberculosis patients diagnosed at the emergency department of a tertiary care hospital in Porto Alegre, South Brazil: a prospective patient recruitment study. BMC Infect Dis 2013; 13:538.

    Article  Google Scholar 

  20. Akrim M, Bennani K, Essolbi A, Sghiar M, Likos A, Benmamoun A, et al. Determinants of consultation, diagnosis and treatment delays among new smear-positive pulmonary tuberculosis patients in Morocco: a cross-sectional study. East Mediterr Health J 2014; 20:707–716.

    Article  CAS  Google Scholar 

  21. Sreeramareddy CT, Panduru KV, Menten J, Van den Ende J. Time delays in diagnosis of pulmonary tuberculosis: a systematic review of literature. BMC Infect Dis 2009; 9:91.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Public Health, Community, Environmental and Occupational Medicine, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt

    Noha M. Abu Bakr Elsaid, Amany H. Refaat & Lamiaa A. Fiala

  2. Department of Health Sciences, Faculty of Health and Rehabilitation Sciences, Princess Noura Bint Abdulrahman University, Riyadh, Saudi Arabia

    Lamiaa A. Fiala

  3. Department of Internal Medicine, Chest Diseases and Tuberculosis, Faculty of Medicine, Suez Canal University, Ring Road, Ismailia, 41522, Egypt

    Eman R. Hamed (MD)

Authors
  1. Noha M. Abu Bakr Elsaid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amany H. Refaat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lamiaa A. Fiala
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eman R. Hamed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eman R. Hamed.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elsaid, N.M.A.B., Refaat, A.H., Fiala, L.A. et al. Delay in the diagnosis and management of tuberculosis among patients in the Suez Canal Area. Egypt J Bronchol 13, 523–530 (2019). https://doi.org/10.4103/ejb.ejb_8_19

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_8_19

Keywords