Diagnosed TB Patients Care Seeking Behavior and Diagnosis Delay in Jogjakarta Province Indonesia

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Diagnosed TB Patients Care Seeking Behavior and
Diagnosis Delay in Jogjakarta Province Indonesia

• RA Ahmad, Y Mahendradhata, A Utarini, SJ deVlas
• Dept of Public Health Gadjah Mada University,
  Indonesia
• Dept. of Public Health Erasmus MC

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TB in Indonesia

• Indonesia is listed as a TB high burden country
  in the world
• In 1995 adopted the WHO recommended DOTS strategy
• In 2000 implemented a nationwide DOTS expansion
  and intensification
• Mainly implemented in public health centers and
  starting in hospitals

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Achievements and challenges

• Achievements
• Met the global target of case detection rate
  (CDR) and treatment success (TS) as stated in MDG
  in 2006
• Three-fold reduction of TB prevalence over the
  past 25 years (Soemantri et al,, 2007)
• Challenges
• Still considered as the 3rd highest TB prevalent
  country (WHO, 2008)
• Parallel health system
• TB patients care seeking behavior
• Reducing diagnostic delay to prevent transmission
  in the community

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Methods

• Setting
• 1 urban and 2 rural districts
• All DOTS health facilities (health centers,
  hospitals and lung clinics)
• Consecutive interview with newly diagnosed TB
  patients
• Construct historical cohort of care seeking
  process
• Data collected socio-demographics background,
  of visits, type of health facility and duration
  from onset of symptoms/their previous visits

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Results
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TB patients characteristics
Age-group
Gender
Type of health facility
Type of tuberculosis
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Diagnostic delay

• Diagnostic delay 0.2 115 weeks
• Median of overall diagnostic delay 6 weeks
• Median of patients delay 1 week
• of visits before diagnosis 1-17 visit(s)
• Median of of visits 4

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Patients movement
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TB patients care seeking process
TB
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Logistic regression

• To predict factors which determine patients
  movement
• Factors included in the analysis
• Gender, age, marital, educational, employment,
  socio-economic status, urban-rural, of visits,
  duration of symptoms

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Patients movement
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Logistic regression

• First visit in a non-alternative services
• No significant factors
• First visit in DOTS over Non-DOTS
• TB patients in urban chose DOTS as their first
  visit (plt 0.000)
• Patients who stayed in DOTS, whether diagnosed or
  not
• of visit as significant factor (plt 0.000)

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Discussion

• TB patients were shopping around before they get
  diagnosed
• Fragmented health system
• There are a lot diagnosis miss-opportunity and
  DOTS providers were not sensitive enough to do
  early detection
• A need to improve detection and referral
  mechanism to ensure continuity of care

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