| BackgroundPulmonary Tuberculosis(TB)is an infectious disease which seriously endangers human health and is an important public health problem in the world and China.According to global TB report of 2016,there were 10.4 million cases of new TB cases in 2015,and the decline of TB incidence rate was only 1.5%.This rate need to reach 5%in order to achieve WHO first milestone of Stop TB strategy by 2020.Therefore,there is a long way to go for the global TB control.In October 2015,the WHO revised the list of countries with high TB burden,suggesting that China is one of 30 countries with high TB burden and one of 30 countries with high burden of multidrug-resistant tuberculosis in the world.The number of pulmonary tuberculosis patient ranks third in the world and is one of the major infectious diseases in China.In the Chinese information system for disease,the morbidity and mortality of pulmonary tuberculosis is one of the top notifiable infectious diseases.The fifth national tuberculosis epidemiological survey reported that in 2010,the prevalence rate of active pulmonary tuberculosis among population aged 15 and above in patients with was 460/10 million.At present,the problems of multi-drug resistance,floating population co-infection of tuberculosis and AIDS make the prevention and control of tuberculosis epidemic more severe.BCG is currently the only vaccine against TB,but it is only effective against children’s miliary and tuberculous meningitis,and has no significant preventive effect on other TB.Therefore,the key of tuberculosis prevention is to discover and regulate treatment management in time.The national tuberculosis prevention and control program requires tuberculosis prevention and control institutions at all levels should detect and treat tuberculosis patients as early as possible,and take various effective measures to improve the early detection of patients.The improvement of the detection rate of TB patients is a difficult problem in our country.The detection quality of TB patients and the quality of following treatment still have weak links.Generally,TB patients who receive standard treatment for more than 2 weeks will have a much lower infectiousness,and TB patients with delayed treatment will increase their probability of transmission in the population and mortality.Due to the lack of public knowledge of tuberculosis prevention and control,tuberculosis patients cannot receive standardized treatment and management from TB institutions at the first time.The fifth national epidemiological survey of TB in 2010 showed that only 6.9%of TB patients received first treatment in tuberculosis prevention and treatment organizations and most of the patients still get their first treatment in other medical institutions,such as general medical institutions,township hospitals and clinics unit.The delay in standardized treatment increased the burden of disease in patients with tuberculosis.Study of delay in detection,analysis of the factors that affect the delay and the reasons for the delay can help relevant departments to issue relevant policies to help increase the early detection rate of TB patients and reduce-the economic burden caused by the disease.It can also reduce the probability of tuberculosis patients spreading in the crowd,thus is helpful to controlling the tuberculosis epidemic.ObjectiveThe main objectives of this study are to analyze the degree of delay in hospital visit,diagnosis and detection among active tuberculosis patients in Jining city,to find out the influencing factors of the delays,so as to provide scientific and effective policy recommendations for minimizing the delays,reducing the burden of tuberculosis,and improving the system of tuberculosis control.MethodsWe selected three out of all eleven counties in Jining as the study sites.A cluster sampling was used to select registered active tuberculosis patients in TB prevention and control institutions in the three counties as the study subjects.The inclusion criterion was the newly diagnosed tuberculosis patients who were being treated.We then investigated the delay in hospital visit,the delay of diagnosis and the influencingfactors.The data was input by Epidata3.2 program,and the consistency test was performed.The data were statistically described and analyzed using SPSS 16.0 software.We adopted descriptive methods to analyze characteristics of delay among new pulmonary tuberculosis patients in Jining city,then unconditional Logistic regression was used to find factors influencing delay of hospital visit,diagnosis and detection.Results1.A total of 249 pulmonary tuberculosis patients was included in the study,97 cases had delay in hospital visit,152 cases did not have delay in hospital visit,the delay rate was 39%;145 patients had diagnosis delay,and 104 patients did not have diagnosis delay,with delayed diagnosis rate of 59.2%;155 cases had delayed detection,94 cases did not have delay,the delay rate was 62.3%.The percentage of sputum smear positive in delayed patients(38.7%)was significantly higher than that in patients with non-delayed patients(16.0%)(P<0.01).Only 59.8 percent of the patients surveyed had the knowledge of tuberculosis.2.Multivariate Logistic regression analysis showed that,taking age group 15～as control group,45～and 60～group were more likely to have delay in hospital visit(OR=3.8 9/OR=2.22);compared with the higher income patients,the lower income patients were more likely to delay in hospital visit(OR=3.81).Patients with hemoptysis were less likely to delay in hospital visit.(OR = 0.08).3.Multivariate Logistic regression analysis showed that,compared to Qufu city,pulmonary tuberculosis patients in other two counties were more likely to have a diagnosis delay(OR=2.42/OR=3.45).The patients with more than 60 minutes of travel time to county TB institute were more likely to have a diagnosis delay(OR=7.05),compared to patients with less than 30 minutes of travel time.In comparison with the higher income,lower income is the risk factor for the diagnosis delay(OR=7.28).Hemoptysis was a protective factor for the delayed diagnosis of pulmonary tuberculosis(OR =0.06).Compared to the first visit in the country hospital and above,first visit in town hospital and village clinics visits were risk factors(OR=4.27/OR= 4.66).4.Multivariate Logistic regression analysis showed that,compared with men,women were less likely to delay in detection of tuberculosis(OR=0.23).Patients with more than 60 minutes of travel time to county TB institute were more likely to have a detection delay,compared to patients in less than 30 minutes of travel time(OR=8.29).In comparison with the higher income,average and lower income were the risk factor for the detection delay(OR=2.48/11.42).In contrast to those who did not know about the free TB policy,it was found that the awareness of the free TB policy is a protective factor for patients with TB(OR=0.16).In contrast with negative sputum smear,positive sputum smear was a risk factor(OR=3.40).Patients with hemoptysis were the protective factors for the delay in tuberculosis patients(OR=0.08).Compared to the first visit in the county level and above hospital,the first visit in the town hospital and village clinics were the risk factors for the detection delay(OR=3.86/OR=3.04).Conclusion1.Delay in hospital visit and diagnosis among new patients with active tuberculosis were serious,and the rate of detection delay rate was 62.3%.Patients who were men,living in rural and remote areas,with lower income had a higher risk of delay.It is suggested that the TB funding investment should be further increased,benefits for TB patients should be broadened,thus to ensure patients receive preferential benefits especially for those in rural and poor areas.Reimbursement for patients in rural areas for their transportation can further reduce the economic burden of TB patients and improve the detection of tuberculosis.2.Patients whose first diagnosis of suspicious pulmonary tuberculosis in village clinics or township hospitals were 4.6 times more likely to be delayed than those whose first visit in hospitals above the county level.It is suggested to increase the training of grassroots medical personnel,improve the diagnosis level of grassroots clinical staff,further improve the construction of tuberculosis prevention and control system,strengthen the construction of the three-level prevention and control network for tuberculosis prevention,implement the centralized management of tuberculosis and establish a perfect referral system to ensure the timely diagnosis of patients treatment.3.It was found that the proportion of positive sputum smear in patients with delay was significantly high than that non-delayed patients.Therefore,we should do well on early detection and treatment of tuberculosis patients,to reduce the sources of infection and the incidence of pulmonary tuberculosis,which was important significance on the aspect of disease control and public health.4.Tuberculosis patients had a limited cognitive level of tuberculosis.Through radio,television,Wechat,Weibo and other effective ways to carry out the multi-level campaign,we could do a good job in advocacy work for tuberculosis to mobilize the whole society to participate and pay attention to tuberculosis control work,so as toimprove the of knowledge of tuberculosis prevention and treatment of public,to increase the rate of timely visits to medical treatment for suspected pulmonary tuberculosis patients and increase patient discovery. |
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