Factors Contributing To Delay In Seeking Treatment Among Pulmonary Tuberculosis Patients In Kibwezi District, Kenya

Abstract

Tuberculosis (TB) is a major global public health problem. The disease is a leading cause of morbidity and mortality in Kenya. TB control has remained a major challenge for the National Leprosy and TB Control Programme (NLTP) especially in this HIV/AIDS era and the emergence of multi-drug resistant TB (MDR-TB). Early identification of cases and commencement of effective chemotherapy is an effective method to control the spread of TB. Reliance by NLTP on passive case finding means that patients play a key role in reducing delay to diagnosis and treatment commencement. Patient delay (duration from onset of symptoms to first contact with a health care provider at a public health facility) is a major challenge to TB control and is dependent on several factors which may have an influence on each other. The purpose of this study was to determine the duration from onset of symptoms to seeking appropriate TB treatment among pulmonary TB (PTB) patients and factors associated with patient delay in the high HIV prevalence Kibwezi District in Kenya. A cross sectional survey of 133 PTB patients was carried out at five public health facilities over a period of 8 weeks. Data collected using a semi- structured questionnaire were entered and analyzed using Epi - Info version 3.4. The mean patient delay and associations between length of patient delay and the various independent variables was determined. Multiple logistic regression was performed to determine the factors independently associated with patient delay. The mean patient delay was 54 days (1.8 months) and 65.4% of the study subjects had delayed for more than 30 days. Private clinics were more preferred (45%) to public health facilities (21%) Delay in seeking the appropriate TB treatment among PTB patients in Kibwezi District was associated with poor perception of services in public health facilities (OR = 4.91; CI: 1.6-15.3; p = 0.0061), visiting a private clinic (OR = 4.24; CI: 1.5-11.6; p = 0.0052) and stigma (OR = 2.46; CI: 1.9-12.2; p = 0.0178). Most PTB patients in Kibwezi District present at public health facilities 30 days after the onset of major TB symptoms. Long delay was associated with having a poor perception of the quality of services in public health facilities, prior attendance at a private clinic and stigma. Delay was not found to be associated with the patients‟ socio-demographic characteristics, knowledge of TB, distance or transport cost to public health facility and perception of TB disease. Neither having a good TB knowledge score nor perceiving TB as a serious disease translated to early care seeking at a public health facility. The findings of this study underscore the need by the Division of Leprosy TB and Lung Disease (DLTLD) to integrate private clinics into the public sector TB control program. The DLTLD supervisory staff can be increased to ensure adherence to standards. Since TB services are integrated in the general health care system, the findings also highlight the need by the Ministry of Public Health and Sanitation (MoPH&S) to improve service delivery in public health facilities so as to correct the poor perception and reduce patient delays. Staff in public health facilities can be trained in communication skills. Educational campaigns should go beyond providing general information about TB to emphasize embracing a positive attitude to prevention of transmission through early treatment.