Title

Factors associated with diagnostic and treatment delays among pulmonary tuberculosis patients in peri-urban areas of Karachi Pakistan : a mixed methods study

Date of Award

2017

Document Type

Thesis

Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)

Department

Community Health Sciences

Abstract

Tuberculosis is one of the huge public health concerns in Pakistan. Currently, amongst TB high burden countries, Pakistan ranks 5th worldwide and accounts for 61% of the TB burden in the World Health Organization Eastern Mediterranean Region. Despite directly observed treatment, short-course (DOTS) coverage, government and different non-governmental organizations efforts, still there is a significant delay in seeking of health care among TB patients in Pakistan. In Karachi tuberculosis case detection rate is 47% and treatment success rate 75%, which is not achieving the standard set by the World Health Organization. As a result, there is increased transmission, morbidity and mortality upsurge in Karachi. Little is known about delays before the start of TB treatment and health seeking behavior of TB patients in peri-urban areas of Karachi. Aim: The aim of this study is to assess health seeking behaviors, diagnostic and treatment delays and its associated factors among pulmonary tuberculosis patients in peri-urban areas of Karachi. Methodology: A cross sectional study was conducted using mix methods. First, a survey was carried out in purposively selected four Marie Adelaide Leprosy Centers (MALC) of Karachi, Pakistan where a total of 240 adult patients of pulmonary tuberculosis were interviewed using structured questionnaire. Followed by quantitative approach, six in depth interviews were conducted with pulmonary tuberculosis patients. Descriptive statistics, chi-square test and multivariate logistic regression methods in SPSS version 20 were employed for quantitative data analysis while qualitative data was analyzed through NVIVO software. Findings: The results showed that 87% patients delay in diagnosis while 24% in treatment. The mean patient delay was 23 days (range 2-90 days), mean hospital delay was 83 days (range 6-400 days), mean diagnostic delay was 90 days (range' 21-400 days), mean treatment delay was 5 days (range 1-30 days) and mean total delay was 106 days (range 10-454 days). Patient's age group, education level, occupation, household members , awareness about disease, stigma and first visit before diagnosis were significantly associated with diagnostic delay of TB. Multivariate logistic regression method identified occupation, awareness about disease and first visit before diagnosis are risk factors of diagnostic delays. The percentage of patients who were aware about tuberculosis was 74 % .The percentage of patients who perceived stigmatization was 50%. Conclusion: Diagnostic delay among pulmonary tuberculosis patient is unacceptably high in peri urban region of Karachi. Patients and health care system both are significantly contributing to these delays. Massive health education is required in communities to reduce patient delays. Furthermore, public private mix (PPM) approaches for expansion of TB care and engaging private practitioners to be included in TB control programs to reduce health system's delays.

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