Proportion and Factors Associated with Delay in the Commencement of TB Treatment in Selected Hospitals in Kwale County, Kenya

Abstract

Tuberculosis is an infectious bacterial disease caused by Mycobacterium tuberculosis which commonly affects the lungs but can affect other parts of the body. With a burden of disease that accounts for over 10 million cases annually (of which less than two thirds are reported), TB is the leading cause of death from a single infectious agent across the world, ranking above HIV/AIDS. In Kenya, Tuberculosis (TB) remains one of the greatest health threats as it is one of the leading causes of death in the economically active age groups and in people living with HIV. Although the most essential component of tuberculosis control is the early detection and treatment of infectious cases, longer intervals from TB symptom onset to TB diagnosis and treatment continue to adversely affect public health and clinical outcomes. Delays in diagnosis and initiation of effective treatment increase morbidity and mortality from tuberculosis as well as the risk of transmission in the community. This study aimed at investigating the factors associated with delay in commencement of TB treatment in selected health facilities in Kwale County, Kenya. Factors assessed included: social demographic factors, proportions of delayed TB treatment, social cultural and health related system factors that constrain early TB diagnosis and treatment among TB patients in Kwale County. The study adopted descriptive cross-sectional study design. Purposive sampling was used to identify the health facilities and interviewer- assisted structured questionnaires were used for primary data collection. Quantitative data was analyzed using SPSS version 20, descriptive analysis was conducted to determine proportions and probit binary regression analysis was done to identify independent variables influencing dependent variables. Qualitative data was organized using framework and thematic methods using NVivo version 12. All the analyses were done at 95% confidence interval. The results of the study showed that 69.4% of TB patients delayed starting TB drugs. Binary regression analysis showed that social demographic characteristics: gender (OR 8.026, 95% CI of OR: 3.659-17.608, P<0.05), (level of education (OR 2.381, 95% CI of OR: 1.413-4.011, P<0.05) and employment status (OR 6.146, 95% CI of OR: 2.086-18.080, P<0.05) significantly influenced TB treatment delay. Inadequacy of TB diagnostic machines, weak surveillance systems and poor roads were factors in health system found to barriers to timely diagnosis and commencement of TB treatment. In the social cultural context, seven thematic areas (stigma, believing in witchcraft, positive TB diagnosis dispute by TB patients, seeking alternative tradition treatment, and buying drugs over the counter, TB inheritance, religious issues) were reported to constrain the commencement of TB treatment. The study concluded that some there is a high proportion of delay in TB treatment among newly diagnosed TB patients attending Kwale sub-County hospital and Msambweni County Referral Hospitals. Sociodemographic factors that influenced this delay were the level of education, gender and employment status. Health care service-related factors such as inadequacy of diagnostic machines and poor road network as well as sociocultural factors such as belief in witchcraft, and buying drugs over the counter were important barriers to timely TB diagnosis and treatment among newly diagnosed TB patients attending Kwale sub-County and Msambweni County Referral hospitals.