DELAYS IN TUBERCULOSIS TREATMENT AND ASSOCIATED FACTORS IN JIMMA ZONE, SOUTHWEST ETHIOPIA

Abstract

BACKGROUND: Ethiopia ranks eighth among the world's 22 countries with a high tuberculosis burden. Despite early introduction of Directly Observed Treatment in Ethiopia since 1991, access to this service, case detection rate, delays in initiation of treatment and treatment success rates remained far behind the WHO target. The objective of this study was to assess factors affecting delay in treatment for tuberculosis in Jimma Zone, Southwest Ethiopia. METHODS: A cross-sectional study was conducted in 12 public health facilities in Jimma zone among TB patients visiting respective TB clinics during their intensive phase of treatments. The study was conducted from September 2005 to January 2006. All newly registered TB patients (in the National TB and Leprosy Control Program (TLCP) in eligible health facilities were included in the study. Data were analyzed using STATA 9.1 computer software. Cox proportional hazards models for each subgroup were constructed separately for each type of delay outcome. RESULTS: The median duration of patient, health system and total delay for treatment were 8, 2, and 10 weeks, respectively. Total delay for tuberculosis treatment was significantly affected by being divorced, uneducated and rural resident (OR (95% CI) =0.62(0.43 0.89), 1.58(1.01 2.49) 1.41(1.15 1.75) respectively) while patient delay was influenced the first two factors (OR (95% CI) = 0.67(0.47 0.94), 1.91(1.26 2.88) respectively). Health system delay was within the range of WHO recommended duration. CONCLUSION: The study showed significant total delay until initiation of treatment. However, there were no difference in delay among all categories of tuberculosis with regards to patients, health system, and total delay for initiation of treatment. Thus, Tuberculosis Control Program should design better strategies to reduce total treatment delays especially for those who have open tuberculosis.