Evaluation Of Timeliness Of Treatment Initiation Among Smear Positive Pulmonary Tuberculosis Patients In Brong Ahafo Region

ABSTRACT

Introduction

Smear positive pulmonary tuberculosis (PTB+) remains the main contributor of total TB burden in Ghana. One untreated PTB+ patient can transmit infection to up to 15 persons in a year. However, the average duration between onset of symptoms and the initiation of TB treatment is unknown in the region though necessary to be targeted and reduced in an effort to reduce transmission of TB in our health facilities and community. The study evaluated the timeliness and factors that influence treatment initiation among smear positive Pulmonary Tuberculosis (PTB) patients.

Methods

A facility based cross sectional study was conducted in six primary health facilities in the Brong Ahafo Region (BAR) of Ghana, from November 2014 to May 2015. Median timeliness of symptoms, diagnosis, treatment initiation and reason for delay were assessed using structured questionnaire interviews and reviews of medical records. Patient delay was defined as presentation to a health care provider more than 21 days after onset of TB-related symptoms and treatment delay as therapy initiated more than 14 days after the first consultation for TB-related symptoms with a HCP. Descriptive statistics was used to determine patient symptoms and diagnosis, health facility and treatment initiation timeliness (delay). Multiple logistic regression analysis was used to identify factors associated with total delay.

Results

The median patient, health facility and total treatment initiation timeliness among 237 smear positive PTB patients measured in days were 30 (IQR 14, 60), 8 (IQR: 4, 10) and 36 (IQR: 25, 69) days respectively. More than half (58.7%) of patients delayed in seeking treatment. Total delay

was found to be associated with: unemployment [AOR = 7.4, 95% CI: 1.3–5.3], fear of losing job [AOR = 3.4, 95% CI: 1.3–8.5], patient first port of call was the traditional healer [AOR = 10.6, 95% CI: 13, 66.8] and initially being treated for HIV [AOR = 4.9, 95% CI: 1.6, 14.8].

Conclusion

The median number of days for treatment initiation among smear positive PTB patients in the study area was 36 days with about 60% of patients delaying in seeking treatment. The study revealed that, private sector including traditional healers were the first choice of treatment for more than two-thirds of the patients in the region. Therefore, a concerted effort should be made in order to improve health seeking behavior of the community on TB and to reduce delays from seeking care after experiencing TB symptoms.