Delay in tuberculosis case-finding and treatment in Mwanza, Tanzania

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Tanzanian Healthcare System

Background:

• Pulmonary tuberculosis (TB) remains a significant public health challenge globally, particularly in high-burden countries like Tanzania.
• Timely diagnosis and initiation of treatment are critical for effective TB control and reducing transmission.
• Delays in the TB care cascade contribute to increased morbidity, mortality, and ongoing transmission within communities.

Purpose of the Study:

• To investigate the factors contributing to delays in initiating treatment for pulmonary tuberculosis.
• To differentiate between patient-related delays and health system-related delays in Mwanza region, Tanzania.

Main Methods:

• A cross-sectional descriptive study was conducted with 296 smear-positive tuberculosis patients in Mwanza region, Tanzania.
• The study analyzed two key delay periods: symptom onset to first healthcare consultation, and healthcare facility reporting to treatment initiation.
• Data collection focused on identifying demographic, educational, and prior healthcare-seeking behaviors influencing delays.

Main Results:

• The mean total delay from symptom onset to treatment initiation was 185 days, with patient delay accounting for approximately 90% (mean 162 days).
• Health system delay averaged 23 days, with longer delays observed in rural health facilities.
• Significant factors prolonging patient delay included residing in rural areas, lower educational attainment, seeking care from traditional healers first, and lack of prior TB information.

Conclusions:

• Substantial delays in pulmonary tuberculosis case-finding exist in Mwanza, Tanzania, predominantly driven by prolonged patient delay.
• Strategies to reduce delays should focus on enhancing health service utilization, increasing public awareness about TB symptoms and available services.
• Integrating private healthcare providers into TB control efforts may also contribute to shortening the diagnostic and treatment cascade.