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Questions and Answers
Questions and Answers
What was the median distance from home to the health facility in kilometers?
What was the median distance from home to the health facility in kilometers?
4
Was the percentage of participants who reported chills 17.5%?
Was the percentage of participants who reported chills 17.5%?
True (A)
What percentage of participants experienced weight loss?
What percentage of participants experienced weight loss?
- 33.1%
- 48.8%
- 66.9% (correct)
- 51.2%
Participants who reported night sweats accounted for ___% of the total.
Participants who reported night sweats accounted for ___% of the total.
Match the education level with the percentage of participants:
Match the education level with the percentage of participants:
How was diagnostic delay defined in the study?
How was diagnostic delay defined in the study?
What criteria defined treatment delay in the study?
What criteria defined treatment delay in the study?
Which statistical test was used to estimate the significance of categorical variables in univariate analysis?
Which statistical test was used to estimate the significance of categorical variables in univariate analysis?
The epidemiologically relevant variables with P-value ≤ 0.1 in univariate analyses were included in the Cox proportional hazard model.
The epidemiologically relevant variables with P-value ≤ 0.1 in univariate analyses were included in the Cox proportional hazard model.
The duration from onset of symptoms to TB diagnosis had a median of __ days.
The duration from onset of symptoms to TB diagnosis had a median of __ days.
What was the median time from the onset of symptoms to TB diagnosis in Cambodia?
What was the median time from the onset of symptoms to TB diagnosis in Cambodia?
What were the factors associated with longer time to TB diagnosis in Cambodia? Select all that apply:
What were the factors associated with longer time to TB diagnosis in Cambodia? Select all that apply:
What was the median time from TB diagnosis to the initiation of treatment in Cambodia?
What was the median time from TB diagnosis to the initiation of treatment in Cambodia?
Using smear microscopy for TB diagnosis in Cambodia was associated with shorter time to treatment initiation. Is this statement true or false?
Using smear microscopy for TB diagnosis in Cambodia was associated with shorter time to treatment initiation. Is this statement true or false?
What is the effect of having a primary or lower education level on the risk of TB?
What is the effect of having a primary or lower education level on the risk of TB?
Is cough associated with a reduced risk of TB?
Is cough associated with a reduced risk of TB?
What factor is associated with self-medication for TB?
What factor is associated with self-medication for TB?
Participants with shorter delays to TB diagnosis consistently reported fear of infecting others and the ill effects of the conditions on wellbeing, work, and ____ prompted TB care-seeking.
Participants with shorter delays to TB diagnosis consistently reported fear of infecting others and the ill effects of the conditions on wellbeing, work, and ____ prompted TB care-seeking.
Participants with shorter delays to TB diagnosis felt ashamed and embarrassed because of TB, while those with longer delays reported both self-perceived and experience of discrimination against TB, indicating a perceived __________.
Participants with shorter delays to TB diagnosis felt ashamed and embarrassed because of TB, while those with longer delays reported both self-perceived and experience of discrimination against TB, indicating a perceived __________.
What were some reasons for seeking private healthcare/self-medication before TB diagnosis mentioned in the text?
What were some reasons for seeking private healthcare/self-medication before TB diagnosis mentioned in the text?
TB stigma had a significant impact on time to diagnosis for all participants.
TB stigma had a significant impact on time to diagnosis for all participants.
What are some factors responsible for longer delays in TB treatment initiation?
What are some factors responsible for longer delays in TB treatment initiation?
What diagnostic tool is mentioned in the content for optimizing TB case detection?
What diagnostic tool is mentioned in the content for optimizing TB case detection?
Delay in TB care-seeking for more than 2 months increases the risk of household infection.
Delay in TB care-seeking for more than 2 months increases the risk of household infection.
Longer treatment delay was noted among TB diagnoses made using __________.
Longer treatment delay was noted among TB diagnoses made using __________.
Match each abbreviation with its meaning:
Match each abbreviation with its meaning:
What is the title of the article published in Biometrika in 1980?
What is the title of the article published in Biometrika in 1980?
Is delayed tuberculosis diagnosis associated with tuberculosis transmission according to Golub et al.?
Is delayed tuberculosis diagnosis associated with tuberculosis transmission according to Golub et al.?
Increased case notification through active case finding of tuberculosis among household and ________ contacts in Cambodia.
Increased case notification through active case finding of tuberculosis among household and ________ contacts in Cambodia.
Which organization published the 'Systematic screening for active tuberculosis: principles and recommendations' in 2013?
Which organization published the 'Systematic screening for active tuberculosis: principles and recommendations' in 2013?
Match the following countries with their publication related to tuberculosis:
Match the following countries with their publication related to tuberculosis:
Questions and Answers
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Study Notes
Study Notes
Background of Tuberculosis in Cambodia
- Tuberculosis (TB) is a leading infectious cause of morbidity and mortality worldwide, with 10 million new cases and 1.2 million deaths in 2018.
- Cambodia is one of the 30 countries with the highest burden of TB, with an estimated incidence of active TB of 302 per 100,000 population in 2018.
- Despite efforts to control and treat TB, every fourth person with TB goes undetected in Cambodia, similar to the global proportion reported in 2018.
Objectives of the Study
- The study aimed to explore the determinants of delayed diagnosis and treatment of TB in Cambodia.
- The study used a mixed-method explanatory sequential design, comprising a retrospective cohort study and in-depth interviews with people with TB.
Study Methods
- The study was conducted in 12 operational districts in Cambodia between February and September 2019.
- A retrospective cohort study of 721 people with TB was conducted, followed by in-depth interviews with 31 people with TB.
- The study assessed factors associated with time to TB diagnosis and treatment initiation using Cox proportional hazards model.
Key Findings
- The median time from the onset of symptoms to TB diagnosis was 49 days (Interquartile range [IQR]: 21–112).
- Longer time to diagnosis was significantly associated with:
- Living in rural areas (Adjusted hazards ratio [aHR] = 1.25; 95% CI: 1.06–1.48)
- TB symptoms (cough, hemoptysis, and night sweats)
- Seeking private health care/self-medication
- Higher self-stigma
- Education level above primary level (inversely associated with longer time to diagnosis)
- The median time from TB diagnosis to treatment initiation was 2 days (IQR: 1–3).
Conclusions
- TB diagnostic delay was substantial in Cambodia.
- Increasing public awareness about TB, reducing stigma, engaging private healthcare providers, and tailoring approaches to rural areas could improve early detection and treatment of TB.### Characteristics of Study Participants
- Total of 721 people with TB participated in the study
- Median age was 61 years, with 36.9% living in an urban setting
- 53.1% of participants were men, and 77.8% were married
- 84.5% of participants had at least primary education
Time from TB Diagnosis to Treatment Initiation
- Median time from TB diagnosis to treatment initiation was 2 days (IQR 1-3)
- Longer time to treatment initiation was associated with TB symptoms (cough, weight loss) and TB diagnosis informed by smear microscopy
- In multivariate analysis, use of smear microscopy for TB diagnosis remained a significant factor associated with longer time to treatment initiation (aHR = 1.50, 95% CI: 1.16-1.95, P = 0.002)
Barriers to TB Care-Seeking
- Lack of awareness and perceived risk of TB were major barriers to care-seeking
- Delayed care-seeking was due to the absence of symptoms or features perceived to be present among people with TB (e.g., severe cough, appearing underweight)
- Long distance or inability to travel for services was also a barrier to care-seeking for some participants
Qualitative Findings
- Participants with short delay reported lack of perceived threat of TB to their health and competing priorities such as work and family commitments as barriers to TB care-seeking
- Participants with longer delay to diagnosis indicated care-seeking at private health facilities or self-medication when symptoms surfaced, which occurred frequently and repetitively prior to TB diagnosis### Scoring Method and Stigma Measurement
- The scoring method used to measure stigma is 0-0-1-1, where 0 = "less than usual", 0 = "no more than usual", 1 = "rather more than usual", or 1 = "much more than usual"
- The stigma score is based on answers to 12 questions, measured on a Likert scale (0 to 3), with 0 being "strongly disagree" and 3 being "strongly agree"
- The minimum score is 0 and the maximum possible score is 36
- The stigma scores are standardized to 50, with higher scores representing a higher level of self-stigma
Characteristics of In-Depth Interview Participants
- The median age of participants is 56 years (IQR: 45-68)
- 58.1% of participants are male, and 41.9% are female
- 51.6% of participants live in urban areas, and 48.4% live in rural areas
- 51.6% of participants experienced a short delay in TB diagnosis, and 48.4% experienced a long delay
- Participants who experienced a long delay in diagnosis reported seeking private healthcare and self-medication prior to TB diagnosis
Facilitators and Barriers to TB Care-Seeking
- Facilitators to TB care-seeking include:
- Encouragement from family members and other TB survivors
- Fear of infecting others and the ill effects of the condition on wellbeing, work, and livelihoods
- Easy access to TB diagnosis provided by non-governmental organizations
- Barriers to TB care-seeking include:
- Lack of perceived risk and susceptibility to TB
- Unable to travel to health facilities due to intolerable symptoms or logistical constraints
- Competing priorities – work, livelihood, and family responsibilities
TB Stigma
- TB stigma is a significant barrier to TB care-seeking
- Participants who experienced TB stigma reported feeling ashamed and embarrassed because of TB
- Stigma was perceived as a barrier to TB care-seeking, particularly in rural areas
Discussion and Conclusion
- The study found that the median time from the onset of symptoms to TB diagnosis in Cambodia is 49 days, which is comparable to other studies in Asia
- Rural areas have a higher delay in diagnosis compared to urban areas
- Seeking private healthcare and self-medication prior to TB diagnosis are significant barriers to early diagnosis
- TB stigma contributes to delayed TB diagnosis
- Addressing TB stigma and engaging the private healthcare sector could improve early detection of TB and reduce the number of missing cases in Cambodia
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