Delay in Diagnosis of Pulmonary Tuberculosis increases the Risk of Pulmonary Cavitation in Pastoralist Settings of Ethiopia
Fentabil Getnet1,4*, Meaza Demissie2, Alemayehu Worku2,3, Tesfaye Gobena4, Rea Tschopp5,6,7, Michael Girmachew8, Gebeyehu Assefa5, Berhanu Seyoum5
1College of Medicine and Health Sciences, Jigjiga University, Ethiopia; 2Addis Continental Institute of Public Health, Addis Ababa, Ethiopia; 3School of Public Health, Addis Ababa University, Ethiopia; 4School of Public Health, Haramaya University, Ethiopia; 5Armauer Hansen Research Institute, Ethiopia; 6Swiss Tropical and Public Health Institute, Switzerland; 7University of Basel, Switzerland; 8Karamara Referral Hospital, Ethiopia
Background: Delay in diagnosis and treatment of pulmonary tuberculosis (PTB) leads to severe disease, adverse outcomes and increased transmission. Assessing the extent of delay and its effect on disease progression in TB affected settings has clinical and programmatic importance. Hence, the aim of this study was to investigate the possible effect of delay on infectiousness (cavitation and smear positivity) of patients at diagnosis in Somali pastoralist area, Ethiopia.
Methods: A cross-sectional study was conducted between December 2017 and October 2018, and 434 newly coming and confirmed PTB patients aged ≥15 years were recruited in five facilities. Data were collected using interview, record-review, anthropometry, Acid-fast bacilli and chest radiography techniques. Log-binomial regression models were used to reveal the association of delay and other factors associated with cavitation and smear positivity, and ROC Curve was used to determine discriminative ability and threshold delays.
Results: Median age of patients was 30 years. Of all, 62.9% were males, and 46.5% were pastoralists. Median diagnosis delay was 49 days (IQR= 33–70). Cavitation was significantly associated with diagnosis delay [P<0.001]; 22.2% among patients diagnosed within 30 days of illness and 51.7% if delay was over 30 days. The threshold delay that optimizes cavitation was 43 days [AUC (95%CI) = 0.67(0.62–0.72)]. Smear positivity was significantly increased in patients delayed over 49 days [p=0.02]. Other factors associated with cavitation were age ≤35 years [APR (95%CI) =1.3(1.01–1.6)], chronic diseases [APR (95%CI)=1.8(1.2–2.6)] and low MUAC*female[APR (95%CI)=1.8(1.2–2.8)]. Smear positivity was also associated with age ≤35 years [APR (95%CI) =1.4(1.1–1.8)], low BMI [APR (95%CI) =1.3(1.01–1.7)] and low MUAC [APR (95%CI) =1.5(1.2–1.9)].
Conclusion: This study highlights delay in diagnosis of pulmonary TB remained high and increased infectiousness of patients in pastoral settings of Ethiopia. Hence, delay should be targeted to improve patient outcomes and reduce transmission in such settings