DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20203398

Factors associated with delays in seeking tuberculosis treatment among patients at Muhima district hospital, Rwanda

Chinenye Mercy Nwankwo, Yasmin Umubyeyi Omar

Abstract


Background: Few studies exist in Rwanda to establish the reasons behind delays in seeking treatment in the health institutions which further affected timely diagnosis and case detection. The study investigated factors associated with delays in seeking treatment among tuberculosis (TB) patients at Muhima District Hospital, Rwanda.

Methods: The study adopted descriptive cross- sectional study of 49 smear-positive TB patients derived using proportion estimation of case registry (November 2016 to January 2017) newly- diagnosed patients, first and second months treatment. Systematic sampling technique used to select 60 TB patients from target population. Data collected by researcher and trained research assistant, using a close- ended questionnaire through a translation in local dialect.

Results: About 49% (24) of the smear- positive TB patients experienced delayed in seeking treatment for more than 180 days (6 months). Also 53% (26) were within the 36-45 age-cohort, while majority 75.5% (37) of the respondents was male. About 57% (28) of the respondents have poor knowledge of TB transmission. Similarly, about 51% (25) were the results on the perception of taking anti- TB medication, while median time interval from onset of symptoms and initiation of treatments was 45 days, average 71 days between 15 -180 days.

Conclusions: Statistically significant relationship exist between initial source of treatment using home remedies (p=0.0) and private insurance cover (p=0.0) in relation to delay, which further contributed to delay among majority. Recommendations of the study are strengthening medical services utilization, improving case detection, medical infrastructures and collaboration with non- formal healthcare practices.


Keywords


Factors associated, Delays in seeking tuberculosis treatment, Patients, Muhima district hospital

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References


Abukar N. Factors influencing delay in seeking tuberculosis treatment in belet- weyne district, somalia. UWC, South Africa. 2008.

Center for Disease Control and Prevention. ‘CDC: Global Fact sheet.’ Atlanta, Georgia. 2016.

Chomi E, Mujinja P, Enemark U, Hansen K and Kihara D. Health care seeking behavior and utilization in a multiple health insurance system: Does insurance affiliation matter. Int J Equity Health. 2014;13:25.

Finnie RK, Khoza LB, Van de Borne B, Mabunda T, Abouchie P, Mullen PD. Factors associated with patient and health care system delay in diagnosis and TB treatment in Sub- Saharan African countries with high burdens of TB and HIV. Trop Med Intl. 2011;16:394-411.

Frieden T. Toman’s Tuberculosis case detection, treatment and monitoring- questions and answers.’ World Health Organization, Geneva, Switerland. 2004.

Gasana M, Vandebrie G, Kabanda G, Mugabo J, Sahabo R, El- Sadr W, et al. ‘Tuberculosis In Rwanda: Challenges to reaching the targets.’ Bulletin for WHO. 2007;85:325-420.

Gebeyehu, E, Azage, M& Abeje G. Factors associated with patients delay in Tuberculosis treatment in Bahir Dar City Administration, Northwest Ethiopia. BMC Public Health. 2014.

Hussen, A, Tessema F, Mohammed S, Keribe K, Deribew A. Treatment delay among pulmonary Tuberculosis patients in pastoralist communities in Bale Zone, Southeast Ethiopia. BMC Public Health. 2012;5:320.

Internal clinical guidelines team. Tuberculosis: prevention, diagnosis, management and service organization. National institute for health and care excellence. 2016.

Kumar R, Wongsa L, Kriangsak V, Koju R, Bhattaraj R. Major delays in the diagnosis and management of Tuberculosis patients in Nepal. J Clin Diagnos Res. 2015;9:10.

Kiwuwa S, Charles K, Harriet M. Patient and health- seeking delay in pulmonary TB patients attending a referral hospital: A cross-sectional study. BMC Public Health. 2008;55:122.

Lusignani L, Quaglio G, Nsuka J, Grainger R, Putoto G, Manenti F, et al. Factors associated with patient and health care system delay in diagnosis for Tuberculosis in the province of Luanda, Angola. BMC Public Health. 2013;13:168.

Mesfin M, Newell J, Walley J, Gessessew A, Madeley R. Delayed consultation among pulmonary Tuberculosis patients: Cross- sectional study of 10 DOTS District in Ethiopia. BMC Public Health. 2009;9:53.

Mfinanga S, Mutayoba B, Kahwa A, Kimaro G, Mtandu R, Ngadaya E, et al. The magnitude and factors associated with delays in management of smear- positive Tuberculosis in Dar es Salaam, Tanzania. BMC Public Health. 2018;8:158.

Mkwakwa L, Sheu M, Chiang C, Lin S, Chang P. Patient and health system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi. BMC Public Health. 2014;14:132.

Musoke D, Boynton P, Butler C, Musoke M. Health seeking behavior and challenges in utilizing health facilities in utilizing health facilities in Wakiso District, Uganda. African health Sci. 2014;14:4.

Mutinda K, Kabiru E, Mwaniki P. Health seeking behavior, practices of TB and access to health care among TB patients in Machakos County, Kenya: A cross- sectional study. BMC Public Health. 2014;7:237.

Ngang N, Ntaganira J, Kalk A, Walter S, Ecks S. Perceptions and beliefs about cough and Tuberculosis implications for TB control in rural Rwanda. INT J Tuberc Lung Dis. 2007;11:108-13.

Nyarugenge District profile: Fourth population and housing census (2012). National Institute of Statistics of Rwanda (NISR). 2012.

Osei E, Akweongo P, Binka F. Factors associated with DELAY in diagnosis among Tuberculosis patients in Hoehoe Municipality, Ghana. BMC Public Health. 2015;7:721.

Rajendra B, Hinderaker S, Enerson D, Malla P, Morke O. Delay in Diagnosis of Tuberculosis in Nepal. BMC Public Health. 2009;9:236.

Ruhara C, Kioko U. Role of insurance in the demand for healthcare in Rwanda: A household level investigation. EARP- EF. 2016;03.

Takarinda K, Harries A, Nyathi B, Ngwenya M, Apoll T, Sandy C. Tuberculosis treatment delays and associated factors, within the Zimbabwe National Tuberculosis Program. 2015;15:29.

Tattevin P, Che D, Fraisse P, Gatey C, Guichard C, Antoine D. Factors associated with health care system delay in the diagnosis of Tuberculosis in France. Int J Tuberc Lung Dis. 2012;16:10-55.

Thakur R, Murhekar M. Delays in diagnosis and treatment among TB patients registered under RNTCP Mandi, Himakal Pradesh, India. BMC Public Health. 2010.

Health Development Initiative (HDI). Tuberculosis, detection, care and treatment for people living with HIV in Rwanda: A Rapid Situation Analysis. 2011.

Ukwaja K, Alobu I, Nweke C, Onyenwe E. Health- seeking behavior, treatment delays, and its determinants among Tuberculosis patients in rural Nigeria: A cross- sectional study. BMC Public Health. 2013;13:25.

Ward H, Marcinuk D, Pahwa P, Hoeppner V. Extent of pulmonary Tuberculosis in patients diagnosed by active compared to passive case findings. Int J Tuberc, Lung Dis. 2004;8:593-7.

Wondimu T, Micheal K, Kassanhun W, Getachew S. Delay in Tuberculosis treatment and factors associated among pulmonary Tuberculosis patients in East Wollega, Western Ethiopia. BMC Public Health. 2007;2:127.

WHO, 2002; Global Tuberculosis report 2002. WHO report 2002 Geneva, Switzerland.

WHO, 2006; Global Tuberculosis report 2006. WHO report 2006 Geneva, Switzerland.

WHO, 2011; Global Tuberculosis Report 2011. WHO report 2011 Geneva, Switzerland.

WHO, 2013; Global Tuberculosis report 2013. WHO report 2013 Geneva, Switzerland.

WHO, 2014; Global Tuberculosis report 2014. WHO report 2014 Geneva, Switzerland.

WHO, 2015; Global Tuberculosis report 2015. WHO report 2015 Geneva, Switzerland.

WHO: Global Tuberculosis control: surveillance, planning, financing. WHO Report 2008. Geneva, Switzerland.

Zhou C, Tobe R, Chu J, Gen H, Wang X, Lu L. Detection delay of pulmonary Tuberculosis patients among migrants in China. Int J Tuberc Lung Dis. 2012;16:1630-6.