Mustafa Hamidullah TÜRKKANI, Çiğdem ÖZDİLEKCAN, Tarkan ÖZDEMİR

Determination of related factors about diagnostic and treatment delays in patients with smear-positive pulmonary tuberculosis in Turkey

Background/aim: This study aimed to analyze delays in diagnosis and treatment by defining the related demographic and clinical factors, to reveal obstacles, and to develop essential attempts to help reduce treatment delays. Materials and methods: We created a questionnaire on the subject of delays in diagnosis and treatment in tuberculosis (TB) control to be administered to the patients. The forms were distributed to dispensaries across the country by the General Directorate of Public Health via an official letter. Results: The study included 853 new patients with smear-positive pulmonary TB. The mean patient delay was 18.06 ± 22.27 days, the mean diagnosis delay was 35.63 ± 34.86 days, and the mean treatment delay was 0.90 ± 2.39 days. We found no association between sex, age, literacy, residential location, the presence of chronic respiratory diseases, and patient delay. It was determined that patient delay was shorter for patients with hemoptysis, fever, dyspnoea, and chest pain. In women, the diagnosis delay was longer than in men. Conclusion: In the diagnosis process of patients with tuberculosis, it was determined that there was an improvement in the patient delay; however, the improvement in the diagnosis delay was still not acceptable as an ideal duration.

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1. World Health Organization. The Global Plan to Stop TB 2011-2015: Transforming the fight towards elimination of tuberculosis. Geneva, Switzerland: World Health Organization, 2010.
2. Republic of Turkey Ministry of Health. The Guideline of Tuberculosis Diagnosis and Treatment. Ankara, Turkey: Republic of Turkey Ministry of Health; 2011 (in Turkish).
3. Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health 2008; 8 (1): 15. doi: 10.1186/1471-2458-8-15
4. World Health Organization. The End TB Strategy, Global strategy and targets for tuberculosis prevention, care and control after 2015. The official text approved by the Sixty seventh World Health Assembly. Geneva, Switzerland: World Health Organization; 2014.
5. Bello S, Afolabi RF, Ajayi DT, Sharma T, Owoeye DO et al. Empirical evidence of delays in diagnosis and treatment of pulmonary tuberculosis: systematic review and metaregression analysis. BMC Public Health 2019; 19 (1): 820. doi: 10.1186/s12889-019-7026-4
6. Zhang ZX, Sng LH, Yong Y, Lin LM, Cheng TW et al. Delays in diagnosis and treatment of pulmonary tuberculosis in AFB smear-negative patients with pneumonia. The International Journal of Tuberculosis and Lung Disease 2017; 21 (5): 544- 549. doi: 10.5588/ijtld.16.0667
7. Noble RC. Infectiousness of pulmonary tuberculosis after starting chemotherapy: review of the available data on an unresolved question. American Journal of Infection Control 1981; 9: 6-10.
8. Loudon RG, Romans WE. Cough frequency and infectivitiy in patients with pulmonary tuberculosis. The American Review of Respiratory Disease 1969; 99: 109-111.
9. Jindani A, Aber VR, Edwards EA, Mitchison DA. The early bactericidal activity of drugs in patients with pulmonary tuberculosis. The American Review of Respiratory Disease 1980; 121: 939-949.
10. Leung EC, Leung CC, Chang KC, Chan CK, Mok TY et al. Delayed diagnosis of tuberculosis: risk factors and effect on mortality among older adults in Hong Kong. Hong Kong Medical Journal 2018; 24 (4): 361-368. doi: 10.12809/ hkmj177081
11. Getnet F, Demissie M, Assefa N, Mengistie B, Worku A. Delay in diagnosis of pulmonary tuberculosis in low-and middleincome settings: systematic review and meta-analysis. BMC Pulmonary Medicine 2017; 17 (1): 202. doi: 10.1186/s12890- 017-0551-y
12. Yimer S, Bjune G, Alene G. Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a crosssectional study. BMC Infectious Diseases 2005; 5: 112.
13. Republic of Turkey Ministry of Health. Turkey Health Transformation Program Evaluation Report (2003-2011). Ankara, Turkey: Republic of Turkey Ministry of Health; 2012 (in Turkish).
14. Yildirim Z, Turkkani MH, Bozkurt H, Islek E, Mollahaliloglu S et al. Effects of the Health Transformation Programme on tuberculosis burden in Turkey. Respiratory Medicine 2013; 107 (12): 2029-2037. doi: 10.1016/j.rmed.2013.09.011
15. Ekim NN, Levent E, Şener MB. Delay in the initiation of antituberculosis treatment. Tuberculosis and Thorax 2000; 48 (1): 12-19 (in Turkish).
16. Çalışır HC, Yurdakul AS, Öğretensoy M. Patient and doctor delay in tuberculosis control. Tuberculosis and Thorax 2001; 49 (2): 252-258 (in Turkish).
17. Okutan O, Kartaloglu Z, Cerrahoglu K, Ilvan A, Tozkoparan E et al. Delay in the diagnosis of Turkish servicemen with pulmonary tuberculosis. Military Medicine 2005; 170 (3): 211- 213.
18. Yılmaz A, Boğa S, Sulu E, Durucu M, Yılmaz D et al. Delays in the diagnosis and treatment of hospitalized patients with smear-positive pulmonary tuberculosis. Respiratory Medicine 2001; 95 (10): 802-805.
19. Güneylioglu D, Yilmaz A, Bilgin S, Bayram U, Akkaya E. Factors affecting delays in diagnosis and treatment of pulmonary tuberculosis in a tertiary care hospital in İstanbul, Turkey. Medical Science Monitor 2004; 10 (2): CR62-67.
20. Ekinci GH, Karakaya E, Ongel EA, Haciomeroglu O, Yilmaz A. Patient and doctor delays in smear-negative and smearpositive pulmonary tuberculosis patients attending a referral hospital in İstanbul, Turkey. The Scientific World Journal 2014; 2014: 158186. doi: 10.1155/2014/158186
21. Okur E, Yilmaz A, Saygi A, Selvi A, Süngün F et al. Patterns of delays in diagnosis amongst patients with smear - positive pulmonary tuberculosis at a teaching hospital in Turkey. Clinical Microbiology and Infection 2006; 12 (1): 90-92.
22. Ibrahim WH, Alousi FH, Al-Khal A, Bener A, AlSalman A et al. Diagnostic delay among adults with pulmonary tuberculosis in a high gross domestic product per capita country: reasons and magnitude of the problem. International Journal of Preventive Medicine 2016; 7: 116.
23. Peri AM, Bernasconi DP, Galizzi N, Matteelli A, Codecasa L et al. Determinants of patient and health care services delays for tuberculosis diagnosis in Italy: a cross-sectional observational study. BMC Infectious Diseases 2018; 18 (1): 690. doi: 10.1186/ s12879-018-3609-4
24. Loutet MG, Sinclair C, Whitehead N, Cosgrove C, Lalor MK et al. Delay from symptom onset to treatment start among tuberculosis patients in England, 2012-2015. Epidemiology and Infection 2018; 146 (12): 1511-1518. doi: 10.1017/ S095026881800167X
25. Chen HG, Wang TW, Cheng QX. Gender and time delays in diagnosis of pulmonary tuberculosis: a cross-sectional study from China. Epidemiology and Infection 2019; 147: e94. doi: 10.1017/S0950268819000049
26. Chen H, Wang T, Liu L, Wang D, Cheng Q. Trend in risk of delay in diagnosis of new pulmonary tuberculosis in Northwest China from 2008 to 2017. BMC Infectious Diseases 2019; 19 (1): 100. doi: 10.1186/s12879-019-3725-9
27. Stjepanović M, Škodrić-Trifunović V, Radisavljević-Pavlović S, Roksandić-Milenković M, Milin-Lazović J et al. Patient, healthcare system and total delay in tuberculosis diagnosis and treatment among Serbian population. Acta Clinica Croatica 2018; 57 (2): 257-263. doi: 10.20471/acc.2018.57.02.05
28. Paramasivam S, Thomas B, Chandran P, Thayyil J, George B et al. Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Kerala. Journal of Family Medicine and Primary Care 2017; 6 (3): 643-648. doi: 10.4103/2249- 4863.222052
29. Seid A, Metaferia Y. Factors associated with treatment delay among newly diagnosed tuberculosis patients in Dessie city and surroundings, Northern Central Ethiopia: a crosssectional study. BMC Public Health 2018; 18 (1): 931. doi: 10.1186/s12889-018-5823-9
30. Auer C, Kiefer S, Zuske M, Schindler C, Wyss K et al. Healthseeking behaviour and treatment delay in patients with pulmonary tuberculosis in Switzerland: some slip through the net. Swiss Medical Weekly 2018; 148: w14659. doi: smw.2018.14659