Care-seeking pathways and diagnostic delays in extrapulmonary TB patients

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2023-12-01 DOI:10.5588/pha.23.0037

Ahmad Wali, N. Safdar, A. Ambreen, S. Tahseen, T. Mustafa

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Abstract

SETTING: This study was conducted at a private tertiary hospital engaged with the TB control programme in the city of Lahore, Pakistan. OBJECTIVE: To assess the healthcare-seeking pathways, different delays and factors associated with delays among the patients who presented in the outpatient department with tuberculous lymphadenitis and pleuritis, the most common manifestations of extrapulmonary TB. DESIGN: This cross-sectional study was conducted prospectively from April 2016 to August 2017. RESULTS: The median age of the 339 patients analysed was 22 years (IQR 17–30); tuberculous lymphadenitis was predominant in females (63%), while pleuritis affected more males (64%). Overall, 62% reported seeking care from healthcare providers before diagnosis, of whom 62% sought care from private facilities, 32% visited facilities >2 times and 8% visited traditional healers. Diagnostic delay was associated with tuberculous lymphadenitis, age 15–44 years, poor socio-economic status and poor TB knowledge. CONCLUSION: There was considerable delay in the management of extrapulmonary TB patients, and the health-system delay was the major contributor, leading to increased patient suffering. Efforts towards minimising health-system delay need to be prioritised for patient screening and diagnosis, with a feasible algorithm that is workable in resource-limited settings.

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肺外结核病患者的就医途径和诊断延误

背景:本研究在巴基斯坦拉合尔市一家参与结核病控制规划的私立三级医院进行。目的:评估门诊结核性淋巴结炎和胸膜炎(肺外结核最常见的表现)患者的求医途径、不同延迟及延迟相关因素。设计:本横断面研究于2016年4月至2017年8月进行前瞻性研究。结果:339例患者的中位年龄为22岁(IQR 17-30);女性以结核性淋巴结炎为主(63%)，男性以胸膜炎为主(64%)。总体而言，62%的人报告在诊断前向医疗保健提供者寻求治疗，其中62%的人从私人机构寻求治疗，32%的人访问设施超过2次，8%的人访问传统治疗师。诊断延迟与结核性淋巴结炎、年龄15-44岁、社会经济地位低下和结核病知识贫乏有关。结论:肺外结核患者的管理存在较大的延误，卫生系统延误是导致患者痛苦增加的主要原因。在患者筛查和诊断方面，需要优先考虑尽量减少卫生系统延误的努力，并采用在资源有限的情况下可行的可行算法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.