Care seeking and treatment related delay among childhood tuberculosis patients in Delhi, India
Care seeking and treatment related delay among childhood tuberculosis patients in Delhi, India
复制标题
DOI：
10.5588/ijtld.16.0563
复制
发表时间：
2017-06-01
影响因子：
4
通讯作者：
Kalra, A.
中科院分区：
文献类型：
--
作者：
Kalra, A.
目的：检查儿童结核病 (TB) 患者开始治疗的延迟情况并确定相关因素。 方法：采用多阶段整群随机抽样策略，从德里修订后的国家结核病控制计划覆盖的 8 个地区结核病中心中选择 175 名儿童结核病患者的父母/护理人员，进行横断面调查采访。使用二元逻辑回归分析来确定相关因素。 结果：患者和卫生系统延迟的中位估计分别为 3 天（范围 1-300）和 41 天（范围 10-397）。总延迟中位数为 52 天（范围 12-553）。在自我报告的延误病例中，64% 的护理人员认为无需治疗症状就会消退。在肺部病例中，患者的性别、主要护理人员的年龄、宗教和社区与患者的延误有关。孩子的出生地和家庭规模与肺外结核病例的延迟相关。第一个提供者的类型和咨询的提供者的数量与卫生系统的延误有关。那些居住地距离第一家医疗机构较远的人（OR 2.2，95%CI 1.18-4.07）更有可能经历长时间的患者延误。 结论：由于卫生系统的严重延误与所咨询的提供者的类型和数量有关，因此需要有针对性的策略，使卫生系统更接近这些特别脆弱的儿童及其护理人员。
OBJECTIVE: To examine delays in treatment initiation among child tuberculosis (TB) patients and to identify associated factors.METHOD: A multistage cluster random sampling strategy was used to select 175 parents/care givers of childhood TB patients from eight district TB centres covered by the Revised National Tuberculosis Control Programme in Delhi for interview in a cross-sectional survey. Binary logistic regression analysis was used to identify associated factors.RESULTS: Median estimated patient and health system delay was respectively 3 (range 1-300) and 41 days (range 10-397). Median total delay was 52 days (range 12-553). Among cases with self-reported delay, 64% of care givers thought that the symptoms would subside without treatment. In pulmonary cases, patient's sex, age of the primary care giver, religion and community were associated with patient delay. The child's place of birth and household size were associated with delay among extra-pulmonary TB cases. Type of first provider and number of providers consulted were associated with health system delay. Those who lived at a greater distance from their first health facility (OR 2.2, 95%CI 1.18-4.07) were more likely to experience prolonged patient delay.CONCLUSIONS: As the considerable health system delays were related to the type and number of providers consulted, targeted strategies are required to bring the health system closer to these particularly vulnerable children and their care givers.