Questions and Answers
What was the median distance from home to the health facility in kilometers?
4
Was the percentage of participants who reported chills 17.5%?
True
What percentage of participants experienced weight loss?
Participants who reported night sweats accounted for ___% of the total.
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Match the education level with the percentage of participants:
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How was diagnostic delay defined in the study?
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What criteria defined treatment delay in the study?
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Which statistical test was used to estimate the significance of categorical variables in univariate analysis?
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The epidemiologically relevant variables with P-value ≤ 0.1 in univariate analyses were included in the Cox proportional hazard model.
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The duration from onset of symptoms to TB diagnosis had a median of __ days.
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What was the median time from the onset of symptoms to TB diagnosis in Cambodia?
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What were the factors associated with longer time to TB diagnosis in Cambodia? Select all that apply:
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What was the median time from TB diagnosis to the initiation of treatment in Cambodia?
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Using smear microscopy for TB diagnosis in Cambodia was associated with shorter time to treatment initiation. Is this statement true or false?
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What is the effect of having a primary or lower education level on the risk of TB?
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Is cough associated with a reduced risk of TB?
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What factor is associated with self-medication for TB?
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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.
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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 __________.
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What were some reasons for seeking private healthcare/self-medication before TB diagnosis mentioned in the text?
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TB stigma had a significant impact on time to diagnosis for all participants.
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What are some factors responsible for longer delays in TB treatment initiation?
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What diagnostic tool is mentioned in the content for optimizing TB case detection?
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Delay in TB care-seeking for more than 2 months increases the risk of household infection.
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Longer treatment delay was noted among TB diagnoses made using __________.
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Match each abbreviation with its meaning:
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What is the title of the article published in Biometrika in 1980?
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Is delayed tuberculosis diagnosis associated with tuberculosis transmission according to Golub et al.?
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Increased case notification through active case finding of tuberculosis among household and ________ contacts in Cambodia.
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Which organization published the 'Systematic screening for active tuberculosis: principles and recommendations' in 2013?
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Match the following countries with their publication related to tuberculosis:
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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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Description
This quiz assesses your understanding of the determinants of delayed diagnosis and treatment of tuberculosis in Cambodia based on a mixed-methods study. It covers the factors contributing to delayed diagnosis and treatment and their implications.
