Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis

Kenaw Tegegne Tefera; Fasil Wagnew; Yihalem Abebe Belay; Dawit Eyayu; Daniel Bekele Ketema

doi:doi:10.11648/j.ajlm.20210604.11

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Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis

Kenaw Tegegne Tefera, Fasil Wagnew, Yihalem Abebe Belay, Dawit Eyayu, Daniel Bekele Ketema

Published in American Journal of Laboratory Medicine (Volume 6, Issue 4)

Received: 10 May 2021 Accepted: 5 July 2021 Published: 13 July 2021

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Abstract

Delay in diagnosis and initiation of effective treatment associated with an increase in morbidity, mortality, and ongoing person-to-person transmission in the community at large. Several studies have been conducted in Ethiopia; however, studies assessing the health system's delay in treating tuberculosis patients have yielded inconsistent and inconclusive results. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. We systematically searched different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus, and Springer link databases for studies published from June 6,1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using a random-effects model in R version 4.0.3 software (for median estimation) and Stata version 14 (for metan). A total of 14 studies with 6161 patients who met predetermined criteria were included. Our meta-analysis showed that the estimated pooled median time of the health system delay was 15.29 (95%CI: 9.94–20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015, the pooled median health system delay was 21.63 (95% CI: 14.38-28.88) days, whereas in studies conducted after 2015, the pooled median time was 9.33 (95% CI: 3.95-14.70) days. Living in rural areas (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. In Ethiopia, this review highlights that patients were delayed more than two weeks in the treatment of tuberculosis. Being a rural resident, was the contributing factor of health system delay. For successful TB control, implementing efforts like providing regular health education to the community about TB emphasizes the rural community and enhancing the quality of care in TB treatment facilities in rural areas could have important implications to reduce health system delay.

Published in	American Journal of Laboratory Medicine (Volume 6, Issue 4)
DOI	10.11648/j.ajlm.20210604.11
Page(s)	42-57
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Health System Delay, Median, Meta-analysis, Tuberculosis, Ethiopia

References

[1]	FMOH. Guideline for management of TB, DR-TB and LeprosyinEthiopia. 2018.
[2]	WHO. Global Tuberculosis report. Executive summary2020.
[3]	WHO. Global Tuberculosis report. 2020.
[4]	Anochie P. How to control the Tuberculosis and HIV/AIDS dual epidemic. Archives of Community Medicine & Public Health. 2015: 026-37.
[5]	WHO. GlobalTuberculosis report. 2017.
[6]	WHO. Global Tuberculosis report. 2019.
[7]	Yimer S, Bjune G, Alene G. Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC infectious diseases. 2005; 5 (1): 112.
[8]	Asefa A, Teshome W. Total delay in treatment among smear positive pulmonary tuberculosis patients in five primary health centers, southern Ethiopia: a cross sectional study. PloS one. 2014; 9 (7): e102884.
[9]	Asres A, Jerene D, Deressa W. Delays to treatment initiation is associated with tuberculosis treatment outcomes among patients on directly observed treatment short course in Southwest Ethiopia: a follow-up study. BMC pulmonary medicine. 2018; 18 (1): 1-11.
[10]	Belay M, Bjune G, Ameni G, Abebe F. Diagnostic and treatment delay among Tuberculosis patients in Afar Region, Ethiopia: a cross-sectional study. BMC public health. 2012; 12 (1): 1-8.
[11]	Ayalew YE, Yehualashet FA, Bogale WA, Gobeza MB. Delay for Tuberculosis Treatment and Its Predictors among Adult Tuberculosis Patients at Debremarkos Town Public Health Facilities, North West Ethiopia. Tuberculosis research and treatment. 2020; 2020.
[12]	Organization WH. Diagnostic and treatment delay in tuberculosis. 2006.
[13]	foundation BMg. Exploring TB care and control within the EthiopianHealth care system; country Assessment. 2016.
[14]	Dharmadhikari AS, Mphahlele M, Venter K, Stoltz A, Mathebula R, Masotla T, et al. Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosis. The International journal of tuberculosis and lung disease. 2014; 18 (9): 1019-25.
[15]	Kipiani M, Mirtskhulava V, Tukvadze N, Magee M, Blumberg HM, Kempker RR. Significant Clinical Impact of a Rapid Molecular Diagnostic Test (Genotype MTBDR plus Assay) to Detect Multidrug-Resistant Tuberculosis. Clinical infectious diseases. 2014; 59 (11): 1559-66.
[16]	Madebo T, Lindtjorn B. Delay in treatment of pulmonary tuberculosis: an analysis of symptom duration among Ethiopian patients. MedGenMed: Medscape general medicine. 1999: E6.
[17]	Golub J, Bur S, Cronin W, Gange S, Baruch N, Comstock G, et al. Delayed tuberculosis diagnosis and tuberculosis transmission. The international journal of tuberculosis and lung disease. 2006; 10 (1): 24-30.
[18]	Virenfeldt J, Rudolf F, Camara C, Furtado A, Gomes V, Aaby P, et al. Treatment delay affects clinical severity of tuberculosis: a longitudinal cohort study. BMJ open. 2014; 4 (6).
[19]	Farah MG, Rygh JH, Steen TW, Selmer R, Heldal E, Bjune G. Patient and health care system delays in the start of tuberculosis treatment in Norway. BMC infectious diseases. 2006; 6 (1): 33.
[20]	Chiang CY, Chang C, Chang R, Li C, Huang R. Patient and health system delays in the diagnosis and treatment of tuberculosis in Southern Taiwan. The international journal of tuberculosis and lung disease. 2005; 9 (9): 1006-12.
[21]	Getnet F, Demissie M, Assefa N, Mengistie B, Worku A. Delay in diagnosis of pulmonary tuberculosis in low-and middle-income settings: systematic review and meta-analysis. BMC pulmonary medicine. 2017; 17 (1): 202.
[22]	Sreeramareddy CT, Qin ZZ, Satyanarayana S, Subbaraman R, Pai M. Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review. The International Journal of Tuberculosis and Lung Disease. 2014; 18 (3): 255-66.
[23]	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.
[24]	Sreeramareddy CT, Panduru KV, Menten J, Van den Ende J. Time delays in diagnosis of pulmonary tuberculosis: a systematic review of literature. BMC infectious diseases. 2009; 9 (1): 91.
[25]	Ohmori M, Ozasa K, Mori T, Wada M, Yoshiyama T, Aoki M, et al. Trends of delays in tuberculosis case finding in Japan and associated factors. The International Journal of Tuberculosis and Lung Disease. 2005; 9 (9): 999-1005.
[26]	Huong NT, Vree M, Duong BD, Khanh VT, Loan VT, Borgdorff MW, et al. Delays in the diagnosis and treatment of tuberculosis patients in Vietnam: a cross-sectional study. BMC public health. 2007; 7 (1): 110.
[27]	Sabawoon W, Sato H, Kobayashi Y. Delay in the treatment of pulmonary tuberculosis: a report from Afghanistan. Environmental health and preventive medicine. 2012; 17 (1): 53-61.
[28]	Takarinda KC, Harries AD, Nyathi B, Ngwenya M, Mutasa-Apollo T, Sandy C. Tuberculosis treatment delays and associated factors within the Zimbabwe national tuberculosis programme. BMC public health. 2015; 15 (1): 29.
[29]	Kansiime C, Kiwuwa SM, Levi M, Asiimwe BB, Katamba A. Health service delay among pulmonary tuberculosis patients presenting to a National Referral Hospital, Kampala, Uganda: a cross sectional study. Pan African Medical Journal. 2013; 15 (1).
[30]	Organization WH. The global plan to stop TB 2011-2015: transforming the fight towards elimination of tuberculosis. 2010.
[31]	Saifodine A, Gudo PS, Sidat M, Black J. Patient and health system delay among patients with pulmonary tuberculosis in Beira city, Mozambique. BMC public health. 2013; 13 (1): 559.
[32]	Makwakwa L, Sheu M-l, Chiang C-Y, Lin S-L, Chang PW. Patient and health system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi. BMC infectious diseases. 2014; 14 (1): 132.
[33]	Basnet R, Hinderaker SG, Enarson D, Malla P, Mørkve O. Delay in the diagnosis of tuberculosis in Nepal. BMC public health. 2009; 9 (1): 236.
[34]	Cox HS, Mbhele S, Mohess N, Whitelaw A, Muller O, Zemanay W, et al. Impact of Xpert MTB/RIF for TB diagnosis in a primary care clinic with high TB and HIV prevalence in South Africa: a pragmatic randomised trial. PLoS Med. 2014; 11 (11): e1001760.
[35]	Hussen A, Biadgilign S, Tessema F, Mohammed S, Deribe K, Deribew A. Treatment delay among pulmonary tuberculosis patients in pastoralist communities in Bale Zone, Southeast Ethiopia. BMC research notes. 2012; 5 (1): 320.
[36]	Sullivan BJ, Esmaili BE, Cunningham CK. Barriers to initiating tuberculosis treatment in sub-Saharan Africa: a systematic review focused on children and youth. Global health action. 2017; 10 (1): 1290317.
[37]	Eltayeb D, Pietersen E, Engel M, Abdullahi L. Factors associated with tuberculosis diagnosis and treatment delays in Middle East and North Africa: a systematic review. Eastern Mediterranean Health Journal. 2020; 26 (4): 477-86.
[38]	Finnie RK, Khoza LB, van den Borne B, Mabunda T, Abotchie P, Mullen PD. Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub-Saharan African countries with high burdens of TB and HIV. Tropical medicine & international health. 2011; 16 (4): 394-411.
[39]	Uplekar M, Organization WH. The Stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals. World Health Organization; 2006.
[40]	David Moher AL, Jennifer Tetzlaff, Douglas G. Altman, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine. 2009.
[41]	https: //en.wikipedia.org/wiki/Ethiopia
[42]	WHO. Diagnostic and treatment delay in Tuberculosis. An in-depth analysis of the health-seeking behaviour of patients and health system response in seven countries of the Eastern Mediterranean Region; 2006.
[43]	Newcastle O. Newcastle-Ottawa: Scale customized for cross-sectional studies In available from https: //static-content.springer.com/esm/.../12889_2012_5111_ MOESM3_ESM.doc. 2018.
[44]	Herzog R, Álvarez-Pasquin MJ, Díaz C, Del Barrio JL, Estrada JM, Gil Á. Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC public health. 2013; 13 (1): 154.
[45]	Tekelab T, Chojenta C, Smith R, Loxton D. Factors affecting utilization of antenatal care in Ethiopia: A systematic review and meta-analysis. PloS one. 2019; 14 (4): e0214848.
[46]	Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003; 327 (7414): 557-60.
[47]	Bogale S, Diro E, Shiferaw AM, Yenit MK. Factors associated with the length of delay with tuberculosis diagnosis and treatment among adult tuberculosis patients attending at public health facilities in Gondar town, Northwest, Ethiopia. BMC infectious diseases. 2017; 17 (1): 145.
[48]	Yimer SA, Bjune GA, Holm-Hansen C. Time to first consultation, diagnosis and treatment of TB among patients attending a referral hospital in Northwest, Ethiopia. BMC infectious diseases. 2014; 14 (1): 19.
[49]	Seid A, Metaferia Y. Factors associated with treatment delay among newly diagnosed tuberculosis patients in Dessie city and surroundings, Northern Central Ethiopia: a cross-sectional study. BMC Public Health. 2018; 18 (1): 1-13.
[50]	Gebreegziabher SB, Bjune GA, Yimer SA. Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study. BMC infectious diseases. 2016; 16 (1): 1-13.
[51]	Tedla K, Medhin G, Berhe G, Mulugeta A, Berhe N. Factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia. PloS one. 2020; 15 (8): e0235411.
[52]	Haboro G, Handiso T, Gebretsadik L. Health care system delay of tuberculosis treatment and its correlates among pulmonary tuberculosis patients in Hadiya Zone public health facilities, Southern Ethiopia. Journal of Infectious Diseases and Epidemiology. 2019; 5 (2): 1-6.
[53]	Adenager GS, Alemseged F, Asefa H, Gebremedhin AT. Factors associated with treatment delay among pulmonary tuberculosis patients in public and private health facilities in Addis Ababa, Ethiopia. Tuberculosis research and treatment. 2017; 2017.
[54]	Datiko DG, Jerene D, Suarez P. Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study. BMC Public Health. 2020; 20 (1): 1-10.
[55]	Alene M, Assemie MA, Yismaw L, Gedif G, Ketema DB, Gietaneh W, et al. Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis. BMC infectious diseases. 2020; 20 (1): 1-9.
[56]	Bilal NK, Herbst CH, Zhao F, Soucat A, Lemiere C. Health extension workers in Ethiopia: improved access and coverage for the rural poor. Yes Africa Can: Success Stiroes from a Dynamic Continent. 2011: 433-43.
[57]	Bello S, Afolabi RF, Ajayi DT, Sharma T, Owoeye DO, Oduyoye O, et al. Empirical evidence of delays in diagnosis and treatment of pulmonary tuberculosis: systematic review and meta-regression analysis. BMC public health. 2019; 19 (1): 820.
[58]	Chen C-C, Chiang C-Y, Pan S-C, Wang J-Y, Lin H-H. Health system delay among patients with tuberculosis in Taiwan: 2003–2010. BMC infectious diseases. 2015; 15 (1): 491.
[59]	Verhagen L, Kapinga R, van Rosmalen-Nooijens K. Factors underlying diagnostic delay in tuberculosis patients in a rural area in Tanzania: a qualitative approach. Infection. 2010; 38 (6): 433-46.
[60]	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 Istanbul, Turkey. Medical Science Monitor. 2004; 10 (2): CR62-CR7.
[61]	Yoon C, Cattamanchi A, Davis JL, Worodria W, den Boon S, Kalema N, et al. Impact of Xpert MTB/RIF testing on tuberculosis management and outcomes in hospitalized patients in Uganda. PloS one. 2012; 7 (11): e48599.
[62]	Leung EC, Leung C, Tam C. Delayed presentation and treatment of newly diagnosed pulmonary tuberculosis patients in Hong Kong. Hong Kong Medical Journal. 2007; 13 (3): 221.
[63]	Lin X, Chongsuvivatwong V, Geater A, Lijuan R. The effect of geographical distance on TB patient delays in a mountainous province of China. The International Journal of Tuberculosis and Lung Disease. 2008; 12 (3): 288-93.
[64]	Belkina TV, Khojiev DS, Tillyashaykhov MN, Tigay ZN, Kudenov MU, Tebbens JD, et al. Delay in the diagnosis and treatment of pulmonary tuberculosis in Uzbekistan: a cross-sectional study. BMC infectious diseases. 2014; 14 (1): 624.
[65]	Jurcev-Savicevic A, Mulic R, Kozul K, Ban B, Valic J, Bacun-Ivcek L, et al. Health system delay in pulmonary tuberculosis treatment in a country with an intermediate burden of tuberculosis: a cross-sectional study. BMC public health. 2013; 13 (1): 250.
[66]	Asemahagn MA, Alene GD, Yimer SA. Geographic Accessibility, Readiness, and Barriers of Health Facilities to Offer Tuberculosis Services in East Gojjam Zone, Ethiopia: A Convergent Parallel Design. Research and Reports in Tropical Medicine. 2020; 11: 3.
[67]	Ayé R, Wyss K, Abdualimova H, Saidaliev S. Patient's site of first access to health system influences length of delay for tuberculosis treatment in Tajikistan. BMC health services research. 2010; 10 (1): 10.
[68]	Rajeswari R, Chandrasekaran V, Suhadev M, Sivasubramaniam S, Sudha G, Renu G. Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India. The International Journal of Tuberculosis and Lung Disease. 2002; 6 (9): 789-95.
[69]	Mahendradhata Y, Syahrizal BM, Utarini A. Delayed treatment of tuberculosis patients in rural areas of Yogyakarta province, Indonesia. BMC public health. 2008; 8 (1): 1-6.
[70]	Zhang T, Tang S, Jun G, Whitehead M. Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups. BMC public health. 2007; 7 (1): 19.
[71]	Tadesse T, Demissie M, Berhane Y, Kebede Y, Abebe M. Long distance travelling and financial burdens discourage tuberculosis DOTs treatment initiation and compliance in Ethiopia: a qualitative study. BMC public health. 2013; 13 (1): 424.
[72]	Hibbett K. ADDRESSING THE BARRIERS TO PROPER HEALTH CARE IN ETHIOPIA. 2018.
[73]	WHO. World health report. shaping the future2003.
[74]	Rural Development Strategy Review of Ethiopia (Internet). 2020.
[75]	Yamasaki-Nakagawa M, Ozasa K, Yamada N, Osuga K, Shimouchi A, Ishikawa N, et al. Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal. The International Journal of Tuberculosis and Lung Disease. 2001; 5 (1): 24-31.
[76]	Barker R, Millard F, Malatsi J, Mkoana L, Ngoatwana T, Agarawal S, et al. Traditional healers, treatment delay, performance status and death from TB in rural South Africa. The International Journal of Tuberculosis and Lung Disease. 2006; 10 (6): 670-5.
[77]	Bai L-Q, Xiao S-Y. Factors associated with diagnostic delay for patients with smear-positive pulmonary tuberculosis in rural Hunan, China. Zhonghua jie he he hu xi za zhi= Zhonghua jiehe he huxi zazhi= Chinese journal of tuberculosis and respiratory diseases. 2004; 27 (9): 617-20.

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Kenaw Tegegne Tefera, Fasil Wagnew, Yihalem Abebe Belay, Dawit Eyayu, Daniel Bekele Ketema. (2021). Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis. American Journal of Laboratory Medicine, 6(4), 42-57. https://doi.org/10.11648/j.ajlm.20210604.11

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ACS Style

Kenaw Tegegne Tefera; Fasil Wagnew; Yihalem Abebe Belay; Dawit Eyayu; Daniel Bekele Ketema. Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis. Am. J. Lab. Med. 2021, 6(4), 42-57. doi: 10.11648/j.ajlm.20210604.11

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AMA Style

Kenaw Tegegne Tefera, Fasil Wagnew, Yihalem Abebe Belay, Dawit Eyayu, Daniel Bekele Ketema. Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis. Am J Lab Med. 2021;6(4):42-57. doi: 10.11648/j.ajlm.20210604.11

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@article{10.11648/j.ajlm.20210604.11,
  author = {Kenaw Tegegne Tefera and Fasil Wagnew and Yihalem Abebe Belay and Dawit Eyayu and Daniel Bekele Ketema},
  title = {Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis},
  journal = {American Journal of Laboratory Medicine},
  volume = {6},
  number = {4},
  pages = {42-57},
  doi = {10.11648/j.ajlm.20210604.11},
  url = {https://doi.org/10.11648/j.ajlm.20210604.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajlm.20210604.11},
  abstract = {Delay in diagnosis and initiation of effective treatment associated with an increase in morbidity, mortality, and ongoing person-to-person transmission in the community at large. Several studies have been conducted in Ethiopia; however, studies assessing the health system's delay in treating tuberculosis patients have yielded inconsistent and inconclusive results. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. We systematically searched different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus, and Springer link databases for studies published from June 6,1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using a random-effects model in R version 4.0.3 software (for median estimation) and Stata version 14 (for metan). A total of 14 studies with 6161 patients who met predetermined criteria were included. Our meta-analysis showed that the estimated pooled median time of the health system delay was 15.29 (95%CI: 9.94–20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015, the pooled median health system delay was 21.63 (95% CI: 14.38-28.88) days, whereas in studies conducted after 2015, the pooled median time was 9.33 (95% CI: 3.95-14.70) days. Living in rural areas (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. In Ethiopia, this review highlights that patients were delayed more than two weeks in the treatment of tuberculosis. Being a rural resident, was the contributing factor of health system delay. For successful TB control, implementing efforts like providing regular health education to the community about TB emphasizes the rural community and enhancing the quality of care in TB treatment facilities in rural areas could have important implications to reduce health system delay.},
 year = {2021}
}

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TY  - JOUR
T1  - Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis
AU  - Kenaw Tegegne Tefera
AU  - Fasil Wagnew
AU  - Yihalem Abebe Belay
AU  - Dawit Eyayu
AU  - Daniel Bekele Ketema
Y1  - 2021/07/13
PY  - 2021
N1  - https://doi.org/10.11648/j.ajlm.20210604.11
DO  - 10.11648/j.ajlm.20210604.11
T2  - American Journal of Laboratory Medicine
JF  - American Journal of Laboratory Medicine
JO  - American Journal of Laboratory Medicine
SP  - 42
EP  - 57
PB  - Science Publishing Group
SN  - 2575-386X
UR  - https://doi.org/10.11648/j.ajlm.20210604.11
AB  - Delay in diagnosis and initiation of effective treatment associated with an increase in morbidity, mortality, and ongoing person-to-person transmission in the community at large. Several studies have been conducted in Ethiopia; however, studies assessing the health system's delay in treating tuberculosis patients have yielded inconsistent and inconclusive results. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. We systematically searched different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus, and Springer link databases for studies published from June 6,1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using a random-effects model in R version 4.0.3 software (for median estimation) and Stata version 14 (for metan). A total of 14 studies with 6161 patients who met predetermined criteria were included. Our meta-analysis showed that the estimated pooled median time of the health system delay was 15.29 (95%CI: 9.94–20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015, the pooled median health system delay was 21.63 (95% CI: 14.38-28.88) days, whereas in studies conducted after 2015, the pooled median time was 9.33 (95% CI: 3.95-14.70) days. Living in rural areas (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. In Ethiopia, this review highlights that patients were delayed more than two weeks in the treatment of tuberculosis. Being a rural resident, was the contributing factor of health system delay. For successful TB control, implementing efforts like providing regular health education to the community about TB emphasizes the rural community and enhancing the quality of care in TB treatment facilities in rural areas could have important implications to reduce health system delay.
VL  - 6
IS  - 4
ER  -

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Author Information

Kenaw Tegegne Tefera

Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
Fasil Wagnew

Department of Pediatrics and Child Health Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
Yihalem Abebe Belay

Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
Dawit Eyayu

Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
Daniel Bekele Ketema

Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia

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APA Style

Kenaw Tegegne Tefera, Fasil Wagnew, Yihalem Abebe Belay, Dawit Eyayu, Daniel Bekele Ketema. (2021). Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis. American Journal of Laboratory Medicine, 6(4), 42-57. https://doi.org/10.11648/j.ajlm.20210604.11

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ACS Style

Kenaw Tegegne Tefera; Fasil Wagnew; Yihalem Abebe Belay; Dawit Eyayu; Daniel Bekele Ketema. Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis. Am. J. Lab. Med. 2021, 6(4), 42-57. doi: 10.11648/j.ajlm.20210604.11

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AMA Style

Kenaw Tegegne Tefera, Fasil Wagnew, Yihalem Abebe Belay, Dawit Eyayu, Daniel Bekele Ketema. Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis. Am J Lab Med. 2021;6(4):42-57. doi: 10.11648/j.ajlm.20210604.11

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@article{10.11648/j.ajlm.20210604.11,
  author = {Kenaw Tegegne Tefera and Fasil Wagnew and Yihalem Abebe Belay and Dawit Eyayu and Daniel Bekele Ketema},
  title = {Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis},
  journal = {American Journal of Laboratory Medicine},
  volume = {6},
  number = {4},
  pages = {42-57},
  doi = {10.11648/j.ajlm.20210604.11},
  url = {https://doi.org/10.11648/j.ajlm.20210604.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajlm.20210604.11},
  abstract = {Delay in diagnosis and initiation of effective treatment associated with an increase in morbidity, mortality, and ongoing person-to-person transmission in the community at large. Several studies have been conducted in Ethiopia; however, studies assessing the health system's delay in treating tuberculosis patients have yielded inconsistent and inconclusive results. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. We systematically searched different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus, and Springer link databases for studies published from June 6,1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using a random-effects model in R version 4.0.3 software (for median estimation) and Stata version 14 (for metan). A total of 14 studies with 6161 patients who met predetermined criteria were included. Our meta-analysis showed that the estimated pooled median time of the health system delay was 15.29 (95%CI: 9.94–20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015, the pooled median health system delay was 21.63 (95% CI: 14.38-28.88) days, whereas in studies conducted after 2015, the pooled median time was 9.33 (95% CI: 3.95-14.70) days. Living in rural areas (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. In Ethiopia, this review highlights that patients were delayed more than two weeks in the treatment of tuberculosis. Being a rural resident, was the contributing factor of health system delay. For successful TB control, implementing efforts like providing regular health education to the community about TB emphasizes the rural community and enhancing the quality of care in TB treatment facilities in rural areas could have important implications to reduce health system delay.},
 year = {2021}
}

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TY  - JOUR
T1  - Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis
AU  - Kenaw Tegegne Tefera
AU  - Fasil Wagnew
AU  - Yihalem Abebe Belay
AU  - Dawit Eyayu
AU  - Daniel Bekele Ketema
Y1  - 2021/07/13
PY  - 2021
N1  - https://doi.org/10.11648/j.ajlm.20210604.11
DO  - 10.11648/j.ajlm.20210604.11
T2  - American Journal of Laboratory Medicine
JF  - American Journal of Laboratory Medicine
JO  - American Journal of Laboratory Medicine
SP  - 42
EP  - 57
PB  - Science Publishing Group
SN  - 2575-386X
UR  - https://doi.org/10.11648/j.ajlm.20210604.11
AB  - Delay in diagnosis and initiation of effective treatment associated with an increase in morbidity, mortality, and ongoing person-to-person transmission in the community at large. Several studies have been conducted in Ethiopia; however, studies assessing the health system's delay in treating tuberculosis patients have yielded inconsistent and inconclusive results. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. We systematically searched different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus, and Springer link databases for studies published from June 6,1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using a random-effects model in R version 4.0.3 software (for median estimation) and Stata version 14 (for metan). A total of 14 studies with 6161 patients who met predetermined criteria were included. Our meta-analysis showed that the estimated pooled median time of the health system delay was 15.29 (95%CI: 9.94–20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015, the pooled median health system delay was 21.63 (95% CI: 14.38-28.88) days, whereas in studies conducted after 2015, the pooled median time was 9.33 (95% CI: 3.95-14.70) days. Living in rural areas (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. In Ethiopia, this review highlights that patients were delayed more than two weeks in the treatment of tuberculosis. Being a rural resident, was the contributing factor of health system delay. For successful TB control, implementing efforts like providing regular health education to the community about TB emphasizes the rural community and enhancing the quality of care in TB treatment facilities in rural areas could have important implications to reduce health system delay.
VL  - 6
IS  - 4
ER  -

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