Factors of delay in the detection and diagnosis of pulmonary tuberculosis in Croatia: A Qualitative study
DOI:
https://doi.org/10.53713/nhsj.v5i2.362Keywords:
tuberculosis, delay, delay patient, delay health care systemAbstract
Delays in the detection, diagnosis and treatment of TB are an obstacle in the control of the disease and may be responsible for a longer period of infectivity at the population level. The objective of this study is to estimate the risk factors that contribute to the delays in TB detection attributed to both the patient and the health care system. The focus group method was applicable in the present study. Study subjects (patients and health care professionals) were divided into two basic groups. A total of 9 patients aged 18 to 76 and 4 health workers (epidemiologist, family physician / general practitioner, microbiology specialist and pulmonology specialist) participated in the focus groups. In more than half of the patients, a delay in diagnosis was observed. The patient delay time frame varied between 2 and 4 months. The reasons for the delayed reporting of TB symptoms to the doctor are the attribution of health problems to temporary medical conditions and, as stated by the respondents, their own stubbornness. Healthcare workers believe that the COVID-19 pandemic has had a negative impact on the recognition of tuberculosis to a certain extent, as all activities were primarily aimed at determining the COVID-19 status of patients with any type of respiratory symptoms. Raising awareness about the risk factors of delay in the detection of tuberculosis among risk groups, the general population and health care professionals will help prevent delays in treatment and further reduce the incidence of TB in the general population.
References
Anamarija, JS., Sanja, PG., Rosanda, M., Mladen, S., & Kornelija, M. (2012). Izgubljeno vrijeme u otkrivanju i početku liječenja tuberkuloze: Što treba napraviti? Arh Hig Rada Toksikol, 63,385-394.https:// DOI: 10.2478/10004-1254-63-2012-2129
Dag, GS., Solomon, Y., & Gunnar, AB. (2008). A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health, 8,15. https://doi:10.1186/1471-2458-8-15
David J R., Trish, M., Neville Q V., & Charlotte, A. (2020). Factors associated with delay in treatment initiation for pulmonary tuberculosis. ERJ Open Res, 6, 00161.https:// doi: 10.1183/23120541.00161-2019
Demissie, M., Getahun, H., & Lindtjorn, B. (2003). Community tuberculosis care through ‘TB clubs’ in rural North Ethiopia. Soc. Sci. Med, 56, 2009–2018. https://doi.org/10.1016/S0277-9536(02)00182-X
Golub, J.E., Bur, S., Cronin, W.A., Gange, S., Baruch, N., Comstock, G.W., & Chaisson, R.E. (2005). Patient and health care system delays in pulmonary tuberculosis diagnosis in a low-incidence state. Int J Tuberc Lung Dis, 9, 992-998.
Hans, L.R. (1999). Epidemiologic Basis of Tuberculosis Control (pp. 11–17). Paris, International Union Against Tuberculosis and Lung Disease. https://tbrieder.org/publications/books_english/epidemiology_en.pdf
Hooi, L.N. (1994). Case-finding for pulmonary tuberculosis in Penang. Med J Malaysia, 49, 223–230. https://www.e-mjm.org/1994/v49n3/Pulmonary_Tuberculosis.pdf
Lawn, SD., Afful, B., & Acheampong, JW. (1998). Pulmonary tuberculosis: diagnostic delay in Ghanaian adults. Int J Tuberc Lung Dis, 2, 635-640.
Lili Victoria, B., Matthew, J.S., Roberto, Z., Carlton, A.E., Kei Alegria, F., & Heinner, G. (2017). Why wait? The social determinants underlying tuberculosis diagnostic delay. Plos One, 12,1-18. https:// doi: 10.1371/journal.pone.0185018
Matthew, J.S., & Carlton, A. E. (2020). COVID-19, tuberculosis, and poverty: preventing a perfect storm. Eur Respir J, 56, 2001348. https://doi: 10.1183/13993003.01348-2020
Mihailo, S., Vesna, ŠT., Staša, RP., Marina RM., Jelena, ML., Uroš, B., Jovana, M., Ivana, B., Milica, SL., Mirjana, S., & Violeta, MV. (2018). Patient, Healthcare system and total delay in tuberculosis diagnosis and treatment among Serbian population. Acta Clin Croat, 57, 257-263.https:// doi: 10.20471/acc.2018.57.02.05
Mustafa Hamidullah, T., Tarkan, O., & Cigdem, O. (2020). Determination of related factors about diagnostic and treatment delays in patients with smear-positive pulmonary tuberculosis in Turkey. Turk J Med Sci, 50, 1371-1379.https:// doi:10.3906/sag-2001-89
Nadia, A., Mahnaz, S., Jamshid, YC., Hosseini., Bizhan, S., & Mohammad, SR. (2020). Total delay, and associated factors in pulmonary tuberculosis patients in Golestan province. Caspian J Intern Med, 11, 67-74. https:// doi: 10.22088/cjim.11.1.67
Paul, H.M., Anupom, R., Jayden, S., & Puneet, S. (2016). Social, historical, and cultural dimensions of tuberculosis. J Biosoc Sci, 48, 206– 232. https://doi.org/10.1017/S0021932015000115
Pronyk, RM., Makhubele, MB., Hargreaves, JR., Tollman, SM., Hausler, HP. (2001). Assessing health seeking behaviour among tuberculosis patients in rural South Africa. Int J Tuberc Lung Dis, 5, 619–627.
Public Health England. (2016). Tuberculosis in England 2016 Report (Presenting Data to End of 2015). London. Retrieved from https://www.tbalert.org/wp-content/uploads/2016/09/PHE_TB_Annual_Report_2016.pdf
Sanja, PG., Davor, P., Nikolina, B., & Tina, B. (2014). Razlike u znanju o tuberkulozi među općom urbanom i studentskom populacijom u Zagrebu. Medicina Flum, 50, 98-105. https://hrcak.srce.hr/118567
Sanja, PG., Vesna, T., Matea, Š., Marina, L., & Marija, A. (2020). Changing pattern of Tuberculosis: Clinical Presentation within a decade – Analysis from South-East Europe. Gerontology & Geriatric Research, 2, 2-7. https://doi: 10.31487/j.GGR.2020.01.08
Solomon, Y., Gunnar, B., & Getu, A. (2005). Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross-sectional study. BMC Infect Dis, 5, 112. https://doi: 10.1186/1471-2334-5-112
Summerland, N., Wouters, E., Mitchell, E. M. H., Ngicho, M., Redwood, L., & Masquillier, C. (2017). Evidence-based interventions to reduce tuberculosis stigma: a systematic review. Int J Tuberc Lung Dis, 21, 581-586. https://repository.uantwerpen.be/docman/irua/9c70b4/146546.pdf
Valerie, A.E., & Stephenie, R.C. (2009). From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav, 13, 1160-1177.https:// doi: 10.1007/s10461-009-9593-3
World Health Organisation. (2023, March 21). Retrieved Jun 29, 2023, from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis
