Abdullah, Noor Hashimah
(2006)
Factors influencing delayed treatment among smear positive pulmonary tuberculosis patients.
Masters thesis, Universiti Sains Malaysia.
Abstract
INTRODUCTION
TB remains a great challenge to public health in Malaysia and worldwide. Delay in
treatment commencement can result in significant increase morbidity, mortality and
transmission. Hence this study is aimed to determine the prevalence of various delays
(patient, health service, diagnosis, initiation and total delay) and to identify the factors
influencing the patient delay and health service delay.
METHOD
A crossectional study was done from October 2004 to June 2005 among 178 smear
positive pulmonary TB patients in four districts in Kelantan (Kota Bharu, Tumpat, Bachok
and Pasir Mas). All patients who fulfilled the inclusion and exclusion criteria and gave
consent were recruited due to limited number of patients. Interviewer guided questionnaire
was administered and medical record was reviewed to gather patient's information.
RESULT
The median and inter-quartile range of patient delay, health service delay, diagnosis delay,
initiation delay and total treatment delay in days were 30.0(76.00), 7.0(14.50), 3.0(4.00),
3.0(4.00) and 64.0(90.25) respectively. Furthermore, the prevalence and 95%CI of
unacceptable delays; patient delay, health service delay, diagnosis delay, initiation delay
and total treatment delay were 46.6%(39.3, 53.3), 45.5%(38.2, 52.8), 48.3%(41.0,55.6),
37.6%(30.5,44.8), 61.8% (54.7,68.9) respectively. In multiple logistic regression analysis,
the significant factors associated with unacceptable patient delay were age (OR: 3.88;95%CI: 1.35, 11.18; p= 0.0 12), distance from home to first health facilities attended (OR:
3.98; 95%CI: 1.56, 1 0.15; p= 0.004), attending the T/CM practitioners (OR: 10.51; 95%CI,
1.80, 55.39; p=0.006), attending the private practitioners (OR: 0.24, 95%CI: 0.09, 0.60;
p= 0.002) and stigma (OR: 4.81; 95%CI: 1.59, 14.60; p=0.006). On the other hand, the
significant factors associated with unacceptable health service delay were negative results
of initial sputum smear (OR: 14.48; 95%CI: 2.30, 91.34; p=0.004), number of visits to
health facilities (OR: 4.99 95%CI: 2.76, 9.03; p= <0.001) and types of first health care
facilities attended (OR: 5. 78; 95%CI: 1.58, 21.11; p= 0.008)
CONCLUSION
This study showed that there was a substantial delay in case finding in Kelantan. Raising
public awareness about symptoms of TB, curability and benefit of utilizing available
governmental health facilities through health education campaign might shorten the patient
delay. Health care personnel in both private and government sectors should be reminded
on the important of early diagnosis and prompt treatment of TB. Traditional and
complementary practitioners should be well-cooperated in contributing to Malaysian health
care system by interacting with both private and governmental health sectors.
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