Family dynamics and diagnostic delay among pulmonary tuberculosis patients in Ile-Ife, South-Western Nigeria

Despite the availability of directly observed treatment short-course, which provides free treatment to patients with tuberculosis, leading to some progress, Nigeria still faces a slow decline in tuberculosis incidence and low case detection. The delay in diagnosis of pulmonary tuberculosis, regarding access to healthcare, has made extensive efforts towards its control and elimination appear unrewarding. This study aimed to assess the relationship between family dynamics and diagnostic delay among patients with pulmonary tuberculosis receiving care in the directly observed treatment short-course centres in Ile-Ife, Nigeria.

A descriptive cross-sectional study of 282 patients on treatment for pulmonary tuberculosis in the directly observed treatment short-course centres in Ile-Ife was conducted. The respondents were recruited using a multistage sampling technique. Data were collected using an interviewer-administered World Health Organization-validated questionnaire on case-finding in tuberculosis patients, the Perceived Social Support Family Scale, and the family adaptability, partnership, growth, affection, and resolve (APGAR) score. Multiple logistic regression was done to determine the family dynamics variables that independently predict diagnostic delay. A p < 0.05 was taken as statistically significant.

The family dynamics of the respondents showed that 68.1% of them had strong family support, with about two-thirds (69.1%) having functional families. The median diagnostic delay before diagnosis was 45 days (range 9-217 days). Having a dysfunctional family (Adjusted Odd Ratio (AOR), 3.87; 95% confidence interval, 1.704-8.777, p = 0.001), monthly family income <₦30,000 (US$56.07; AOR, 2.96; 95% confidence interval, 1.358-6.453, p = 0.006), and family size larger than 6 (AOR, 2.223; 95% confidence interval, 1.212-4.076, p = 0.010) were significant predictors of prolonged diagnostic delay.

Family factors predicting diagnostic delay were large family size, low family income, and family dysfunction. There is a need to increase tuberculosis diagnostic access to families with these characteristics.