Socio-demographic Factors Associated with Treatment Initiation Delays among Tuberculosis Patients in Namibia

Main Article Content

Francis F. Chikuse
Loveness N. Dzikiti
Auxilia Chideme-Munodawafa
Talkmore Maruta
Greanious A. Mavondo
Munyaradzi Mukesi
Mathew Maisiri
Patricia T. Gundidza
Munyaradzi M. Soko

Abstract

Background: Delayed tuberculosis (TB) treatment increases the rate of spread of the bacilli in the community and mortality rates. Rapid diagnosis and early TB treatment initiation are crucial to successful outcomes and delays affect TB control programs. In Namibia, there is a paucity of data on the demographic factors affecting TB treatment initiation since GeneXpert MTB/RIF (Xpert) assay was introduced in 2017.

Methods: This was a descriptive cross-sectional retrospective study conducted at Katutura Hospital TB clinic from 1st July 2018 to 31st March 2019. A total of seventy-two (72) participants comprising twenty-five (25) rifampicin resistant-TB (RR-TB) and forty-seven (47) non- RR-TB adult patients were enrolled using consecutive sampling. Patients’ medical records, Xpert results and a questionnaire were used to collect data. The data were analyzed using Stata statistical software version 12. Association between socio-demographic factors and treatment initiation delays were established using logistic regression analysis.

Results: Staying with a TB patient (AOR=17.22, 95% CI: 2.29-129.773), employment status (AOR=1.23, 95% CI, 002-129), previous TB treatment (AOR=2.19, 95% CI: 0.076-0.86) and being HIV positive (AOR= 1.23, 95% CI: 0.0034-057) were the socio-demographic factors that were significantly associated with treatment initiation delays. Treatment initiation delay median time at Katutura Intermediate Hospital TB Clinic was 10 days (IQR: 1-32) and 3 days (IQR: 0-12) for RR-TB and non- RR-TB respectively.

Conclusion: The prolonged treatment initiation delays among HIV positive RR-TB patients might be due to low adherence to HIV care interventions. Staying with a household TB patient and those who were previously treated for TB were also associated with treatment initiation delays. Poor health systems infrastructure and stigma could be the determinants of this delay in these groups. An integrated family-based approach to TB and HIV care involving health care workers can mitigate TB treatment delays post-diagnosis. Further studies should explore the factors associated with late initiation to second-line treatment from a community perspective. Lastly, there is a need to assess the cost-utility of bedaquiline and delamanid drugs roll-out in Namibian health care in comparison with the standard treatment.

Keywords:
Socio-demographic, Rifampicin resistant TB, treatment initiation, Genexpert MTB/RIF assay, cross-sectional study.

Article Details

How to Cite
Chikuse, F. F., Dzikiti, L. N., Chideme-Munodawafa, A., Maruta, T., Mavondo, G. A., Mukesi, M., Maisiri, M., Gundidza, P. T., & Soko, M. M. (2019). Socio-demographic Factors Associated with Treatment Initiation Delays among Tuberculosis Patients in Namibia. Journal of Advances in Medicine and Medical Research, 31(2), 1-11. https://doi.org/10.9734/jammr/2019/v31i230282
Section
Original Research Article

References

World Health Organization. Global Tuberculosis Report; 2018.
[Retrieved on 1 March 2019 from]
Available:https://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf

Kambli P, Ajbani K, Sadani M, Nikam C, Shetty A, Udwadia Z, et al. Defining multi-drug resistant tuberculosis: Correlating GenoType MTBDR plus assays results with minimum inhibitory concentrations. Diagn Microbiol Infect Dis. 2015;82:49 - 53.

World Health Organisation. Stop TB Partnershi; 2017.
[Retrieved on 27 March, 2018]
Available: http://www.newtbdrugs.org/

Ministry of Health and Social Services. National Tuberculosis and Leprosy Control

Programme 2015/2016; 2017.
[Retrieved May 31, 2018, from Republic of Namibia Google Scholar]

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;18:931.

Ministry of Health and Social Services. National guidelines for the management of Tuberculosis; 2011.
[Retrieved May 21, 2018, from Republic of Namibia Google Scholar]

Centers for disease prevention and prevention. The social ecological model: A Framework for Prevention; 2015.
[Retrieved February 1, 2018]
Available:http://cdc.gov/violenceprevention/overview/social-ecologicalmodel

Wai PP, Shewale HD, Kyaw NT, Thein S, Si Thu A, Kyaw KW, et al. Community-based MDR-TB care project improves treatment initiation in patients diagnosed with MDR-TB in Myanmar;2018.
[Retrieved May 31, 2018]
Available:https://doi.org/10.1371/journal.pone.0194087

Takarinda KC, et al. Tuberculosis treatment delays and associated factors within the Zimbabwe National Tuberculosis Programme and IBMC Public Health; 2015.

Munoz-Sellart M, Cievas LE, Tumato M, Merid Y, Yassin M. Factors associated with poor tuberculosis treatment outcome in the Southern Region of Ethiopia. The International Journal of Tuberculosis and Lung Disease. 2010;14(8):973-979.

Hirpa S, Medhin G, Girma B, Melese M, Mekonen A, Suarez P, et al. Determinants of multi–drug-resistant Tuberculosis in patients who underwent first-line treatment in Addis Ababa: A case control study. BMC Public Health. 2013;13:782.

Rifat M, Hall J, Oldmeadow C, Husain A, Milton A. Health system delay in treatment of multidrug resistant tuberculosis patients in Bangladesh. BMC Infectious Diseases. 2015;15:526.

Jacobson KR, Theron D, Kendall EA, Franke MF, Barnard M, van Heden PD, et al implementation of genotype MTBDRplus reduces time to multidrug-resistant tuberculosis therapy initiation in South Africa. Clin Infect Dis. 2013;3;56(4):503 - 508.

Hoa NB, Khanh PH, Chinh NV, Henning CM, et al. Prescription patterns and treatment outcomes of MDR-TB patients treated within and outside the National Tuberculosis Programme in Pham Ngoc Thach hospital, Vietnam. Trop Med Int Health. 2014;19(9):1076-1081.

Hossain M, Kulanthayan KC. Socio-demographic, environmental and caring risk factors for childhood drowning deaths in Bangladesh. BMC Pediatrics. 2015;15: 114.

Amukugo H, Nangombe J. Quality health care delivery at health facilities in the Ministry of Health and Social Services in Namibia. Nursing & Care Open Access Journal. 2017;2.

Asres B, et al, 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;18:64.

Van der Water B, Bettger J, et al. Time to drug-resistant Tuberculosis treatment in a prospective South African Cohort. Global Pediatric Health. 2017;4:1–8.

Evans D, Schmippel K, Govathson C, Sineke T, Black A, Long L, et al. Treatment initiation among persons diagnosed with drug resistant Tuberculosis in Johannesburg, South Africa; 2017.
[Retrieved March 2018]
Available:https://doi.org/10.1371/journl.pone.0181238

Schnipel K. et al. Effect of bedaquiline on mortality in South African Patients with Drug-resistant Tuberculosis: A Retrospective Cohort Study. Lancet Respir Med; 2018.