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Determinants of Delay in Diagnosis and Treatment of Pulmonary Tuberculosis in Malawi
Other Title
Determinants of Delay in Diagnosis and Treatment of Pulmonary Tuberculosis in Malawi
Type
thesis
Date Issued
2012-06-04
Author(s)
隆巴尼
Advisor
許玫玲
Subjects
系所名稱：醫務管理學研究所
Publisher
醫務管理學研究所
Description
學位別：碩士
語文別：英文
指導教授：許玫玲
共同指導教授：
口試委員：林先和;江振源;張武修;余廣亮
中文關鍵字：Patient delay;health system delay;tuberculosis;case detection
語文別：英文
指導教授：許玫玲
共同指導教授：
口試委員：林先和;江振源;張武修;余廣亮
中文關鍵字：Patient delay;health system delay;tuberculosis;case detection
Abstract
BACKGROUND: Malawi has operated a National Tuberculosis (TB) control Program since 1984
providing TB services and medications for free to all suspected pulmonary TB patients in the
country. However, TB control remains a challenge in the country as revealed by the low case
detection rate which is estimated at 65% (2010), which is well below the WHO target of 70%. This
indicates a delay in the diagnosis and treatment of the disease among pulmonary TB cases.
OBJECTIVES: To determine the extent of, and identify the factors associated with patient and
health system delay in the diagnosis and treatment of TB among new and retreatment TB cases in
Malawi.
METHOD: A hospital based cross-sectional survey of 588 pulmonary TB patients from three TB
registration centres, Blantyre, Lilongwe and Mzuzu between July and December 2011. Face to face
interviews were employed using a semi-structured questionnaire to collect information related to the
delay in diagnosis and treatment of TB among new and retreatment cases.
RESULTS: The new TB cases represented 78.2% of the total cases. The median patient delay was
14 days (range 0 – 150) which was the same for both new and retreatment cases. The median health
system delay was 56 days (0 - 733), 59 days for new cases and 40.5 days for retreatment cases.
Median total delay was 80 days. Primary education, knowing cough lasting > 3 weeks as a TB
symptom, and distance were associated with patient delay. The first place of patient visit, and
having chest x-ray examination on diagnosis were associated with health system delay.
CONCLUSION: The health system delay was significantly longer than patient delay. To reduce the
health system delay, the health system needs to be sensitized and the capacity of some non-TB
diagnostic facilities need to be enhanced to allow peripheral diagnosis that would ensure prompt
referral, diagnosis and treatment of TB. Promote educational interventions in schools and the
general public to increase awareness on TB especially on when and where to find TB services.
providing TB services and medications for free to all suspected pulmonary TB patients in the
country. However, TB control remains a challenge in the country as revealed by the low case
detection rate which is estimated at 65% (2010), which is well below the WHO target of 70%. This
indicates a delay in the diagnosis and treatment of the disease among pulmonary TB cases.
OBJECTIVES: To determine the extent of, and identify the factors associated with patient and
health system delay in the diagnosis and treatment of TB among new and retreatment TB cases in
Malawi.
METHOD: A hospital based cross-sectional survey of 588 pulmonary TB patients from three TB
registration centres, Blantyre, Lilongwe and Mzuzu between July and December 2011. Face to face
interviews were employed using a semi-structured questionnaire to collect information related to the
delay in diagnosis and treatment of TB among new and retreatment cases.
RESULTS: The new TB cases represented 78.2% of the total cases. The median patient delay was
14 days (range 0 – 150) which was the same for both new and retreatment cases. The median health
system delay was 56 days (0 - 733), 59 days for new cases and 40.5 days for retreatment cases.
Median total delay was 80 days. Primary education, knowing cough lasting > 3 weeks as a TB
symptom, and distance were associated with patient delay. The first place of patient visit, and
having chest x-ray examination on diagnosis were associated with health system delay.
CONCLUSION: The health system delay was significantly longer than patient delay. To reduce the
health system delay, the health system needs to be sensitized and the capacity of some non-TB
diagnostic facilities need to be enhanced to allow peripheral diagnosis that would ensure prompt
referral, diagnosis and treatment of TB. Promote educational interventions in schools and the
general public to increase awareness on TB especially on when and where to find TB services.