Total delay and associated factors among tuberculosis patients in Jimma Zone, Southwest Ethiopia

PLOS ONE RESEARCH ARTICLE Total delay and associated factors among tuberculosis patients in Jimma Zone, Southwest Ethiopia Berhane Megerssa Ereso ID1,2*, Mette Sagbakken3, Christoph Gradmann1, Solomon Abebe Yimer4,5 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway, 2 Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia, 3 Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Met- Oslo Metropolitan University, Oslo, Norway, 4 Department of Microbiology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway, 5 Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway * Abstract OPEN ACCESS Citation: Ereso BM, Sagbakken M, Gradmann C, Yimer SA (2023) Total delay and associated factors among tuberculosis patients in Jimma Zone, Southwest Ethiopia. PLoS ONE 18(2): e0281546. https://doi.org/10.1371/journal.pone.0281546 Editor: Wenhui Mao, Duke University, UNITED STATES Background Delays in diagnosis and treatment of tuberculosis (TB) increases severity of illness and continued transmission of TB in the community. Understanding the magnitude and factors associated with total delay is imperative to expedite case detection and treatment of TB. The aim of this study was to determine the length and analyze factors associated with total delay. Received: January 28, 2022 Accepted: January 25, 2023 Published: February 9, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0281546 Copyright: © 2023 Ereso et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All data analyzed during the present study are within the paper and its Supporting Information files. Funding: This study was not funded by a grant. It is part of a PhD project and was supported by the Methods Analytic cross-sectional study was conducted in Jimma Zone, Southwest Ethiopia. All newly diagnosed TB patients > 15 years of age were included from randomly selected eight districts and one town in the study area. A structured questionnaire was applied to collect socio-demographic and clinical data. The median total delay was used to dichotomize the sample into delayed and non-delayed patient categories. Logistic regression analysis was used to analyse the association between independent and outcome variables. A p-value < 0.05 were considered statistically significant. Results A total of 1,161 patients were included in this study. The median total delay was 35 days. Patients who had swelling or wound in the neck region were more likely to be delayed than their counterpart [adjusted odds ratio (AOR) = 3.02, 95% confidence interval (CI): 1.62, 5.62]. Women were more likely to experience longer total delay (AOR = 1.46, 95% CI:1.00, 2.14) compared to men. Patients who had poor knowledge of TB were more likely to be delayed compared to those who had good knowledge (AOR = 3.92, 95% CI: 2.65, 5.80). PLOS ONE | https://doi.org/10.1371/journal.pone.0281546 February 9, 2023 1 / 20 PLOS ONE Strategic and Collaborative Capacity Development in Ethiopia and Africa (SACCADE) Project, Norwegian Program for Capacity Development in Higher Education and Research for Development (NORHAD), University of Oslo. There was no additional external funding received for the current study Total delay and associated factors among tuberculosis patients Conclusion The present study showed long total delay in diagnosis and treatment of TB. Targeted interventions that enhance TB knowledge and practice, expedite early suspect identification, referral and management of all forms of TB is imperative to reduce total delay in diagnosis and treatment of TB. Competing interests: The authors have declared that no competing interests exist. 1. Introduction Tuberculosis (TB) is a major cause of illness in low-resource countries. It is among the top 10 causes of death, and has been the leading cause of death from a single infectious agent in recent years [1, 2]. There were an estimated 10.0 million TB cases, and 1.5 million deaths due to TB in 2020 [3]. The 30 high TB burden countries are responsible for the majority (86%) of the estimated incident TB cases [2]. Ethiopia is among the high TB burden countries [3]. TB is a major public health problem and one of the leading infectious diseases in Ethiopia. There were an estimated 140 new incident TB cases per 100,000 population in 2020 and TB mortality rate of 19 per 100,000 populations in 2019 in Ethiopia [4]. Ethiopia accounts for 90,000 (3%) of annually missed TB cases worldwide [2, 5]. A recent national case detection rate of all forms of TB was 76 percent, which is below the target of World Health Organization [3, 6]. One of the contributing factors for low case detection is the delay in diagnosis and treatment of TB. Delay in diagnosis and treatment is commonly divided into three components (patients’ delay, health system’s delay and total delay). While patient delay refers to the delay period from onset of the major TB symptoms to first visit to a medical provider, health system delay encompasses the delay period from first visit to a medical provider to first start of anti-TB treatment. Total delay is defined as the delay period from start of major TB symptoms to first start of anti-TB treatment. Delay in TB diagnosis and treatment remains a major problem of TB control program generally in low and middle income countries [7] particularly in Ethiopia [8, 9]. Patients’ health care seeking delay differs among different regions of Ethiopia [10, 11]. Prompt diagnosis and treatment is crucial for efficient TB control program performance and achieving the End TB targets. The target set for the End TB Strategy for the year 2035 include: 1) reduction of TB mortality by 95%, 2) decreasing TB incidence by 90% (i.e compared to the baseline of 2015), and 3) to certify that no family is suffered with TB related catastrophic costs [12]. The End TB Strategy targets can only be realized if diagnosis, treatment, and preventive services for TB are delivered based on the context of universal health coverage, which implies that all people with TB should be early detected and properly treated [2, 5]. Delayed diagnosis and treatment of TB cases has major role in the transmission of the disease in the community in most high TB burden countries. Early diagnosis and proper treatment of TB will re (...truncated)