Abstract:
Background:- Tuberculosis has been recognized as a major public health problem in Ethiopia and efforts to control it have begun since the early 1960s. Delay in TB diagnosis increase morbidity, mortality, expenditure, and transmission in the community. The objective of the study was to assess the magnitude and associated factors of delay in diagnosis of tuberculosis patients in Horo Guduru Wollega Zone Western Ethiopia, 2021.
Methods: Institution-based cross-sectional study design triangulated by qualitative method was employed from August 10 to September 10, 2021. A total of 271 all forms of TB patients were enrolled. The data was collected by structured and pretested questionnaire. Qualitative data were collected from 36 participants through in-depth interview. The quantitative data were entered to Epi-info version 7.0 and analyzed by using SPSS version 20 computer software program. Descriptive statistics, Bivariate and multivariate analysis were carried out and the result was presented using odds ratio with its 95% confidence interval. Significance was declared by p-value of <0.05. The transcribed and translated qualitative data was analyzed by thematic analysis.
Result: From 275 TB patients the response rate was 271 (98.5%). Accordinglly, the mean age of study participants was 37.3 (SD = ±12.5) years. The magnitude of patient delay, health system and total Tuberculosis diagnostic delay were 148(50.9%), 141(52.0%) and 143 (52.8%) respectively. Patient delay was significantly associated with being female (AOR= 2.67; 95% CI: 1.34-5.34), not having health insurance (AOR= 2.42; 95% CI: 1.24-4.73), longer traveling time (AOR=2.89; 95%CI: 1.35-6.18), poor knowledge about TB (AOR= 2.08; 95% CI: 1.03-4.19) and, ambulatory health status (AOR = 0.19; 95% CI: 0.04-0.80). Larger family size (AOR= 2.76; 95% CI: 1.25-6.02), Extrapulmonary Tuberculosis (AOR = 5.41; 95% CI: 1.16–25.15), Smear negative pulmonary Tuberculosis (AOR= 3.25; 95% CI: 1.20–8.84), first visit to health post (AOR= 4.24; 95% CI: 1.07-16.72) and number of visits less than two times (AOR= 0.06: 95%CI: 0.01-0.27) were factors related to health system delay. Total diagnostic delay is associated with being not community based health insuransce member (AOR= 2.23; 95% CI: 1.14 - 4.33) longer traveling time (AOR= 2.31; 95% CI: 1.06–5.01), type of diagnostic test (AOR = 2.84; 95% CI: 0.03–0.89) and ambulatory functional status (AOR= 0.18; 95% CI: 1.09–7.41).
Conclusion: In the study area, more than half of the TB patients were delayed more than cut-off of patient, health system, and total TB diagnosis delay. Being female, not having CBHI, longer traveling time, ambulatory functional status, and poor knowledge were factors associated with patient delay. Whereas health system delay was associated with family size, type of TB, type of health facility visited first, and number of visits, and the total delay was associated with not having CBHI, traveling time, functional status, and the type of diagnostic test used
