Influence of Healthcare Facility Utilized on Pulmonary Tuberculosis Treatment Delay in South West Nigeria

INTRODUCTION: Delayed tuberculosis (TB) therapy may increase the risk of disease progression, inappropriate treatment, development of multi-drug resistant tuberculosis (MDR-TB) and poor prognosis. Delayed DOTS treatment may be due to healthcare facilities utilized by patients. Nigeria has one of the highest national burdens of pulmonary tuberculosis (PTB) in Africa but there is limited information on treatment delays and the associated factors among TB patients. The objectives of the study were to estimate treatment delay among TB patients and the influence of healthcare facilities (HCF) utilized. 

METHODS: This was a cross-sectional study of new TB patients within intensive treatment phase at DOTS centres in Oyo State south west Nigeria. Multistage sampling technique was used to sample the 403 estimated respondents from urban and rural DOTS centres. Treatment delay was defined as time from onset of symptoms to commencement of DOTS therapy. Kaplan-Meier survival analysis was used to compare treatment delay, while Cox regression analysis was used to assess influence of HCF utilized on DOTS treatment delay.

RESULTS: In all, 403 respondents were studied 204 urban and 199 rural. Mean age of respondents was 37.8 + 12.3 years. The median number of HCF utilized before accessing DOTS centres was 2 (range 1 – 6). The Kaplan-Meier estimation of median treatment delay was 45 days (range 2 – 363 days) overall: rural 40 days (range 6 – 344 days) versus urban 49 days (range 2 – 363 days); p = 0.001. However, median patient time to first HCF was 4 days. The Cox regression model showed significant risk in treatment delay associated with utilization of patent medicine vendors, traditional medicine, private hospitals and government secondary healthcare facilities but, utilization of PHCs reduced the risk of delay treatment.

CONCLUSIONS: Tuberculosis patients seek care early but, prolonged treatment delay could be attributed to influence of non-DOTS HCF.