Dalya Eltayeb1, Elize Pietersen2, Mark Engel2, Leila Abdullahi3. 1. Department of Public Health and Family Medicine, University of Cape Town, Anzio Road Observatory, Cape Town, South Africa. 2. Department of Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road Observatory, Cape Town, South Africa. 3. Vaccines for Africa Initiative, University of Cape Town, Anzio Road Observatory, Cape Town, South Africa.
Abstract
BACKGROUND: Political instability, economic sanctions and substandard quality of health care negatively affect tuberculosis (TB) control in the Middle East and North Africa (MENA) region. AIMS: We aimed to elucidate factors contributing to delays in TB diagnosis and treatment in MENA countries. METHODS: Two reviewers independently appraised eligible articles identified through comprehensive searching and extracted data which were subjected to meta-analysis. RESULTS: Delays in TB diagnosis were associated with older age and low income [(OR = 1.49; 95% CI: 1.31-1.70) and (OR = 1.26; 95% CI: 1.09-1.45)] respectively (n = 17 studies). Being female was associated with patient delay and health system delay [(OR = 1.24; 95% CI: 1.02-1.50) and (OR = 1.68; 95% CI: 1.18-2.38)] respectively. Knowledge and perception of TB, having employment and low levels of crowding were each protective against patient delay. The GRADE system rated the evidence as of low quality. CONCLUSION: This review provides evidence for facilitators and barriers to TB diagnosis and health system delays. For successful TB control in the MENA region, TB awareness and interventions targeting the elderly and those from lower-income settings, particularly directed at gender differences, are essential.
BACKGROUND: Political instability, economic sanctions and substandard quality of health care negatively affect tuberculosis (TB) control in the Middle East and North Africa (MENA) region. AIMS: We aimed to elucidate factors contributing to delays in TB diagnosis and treatment in MENA countries. METHODS: Two reviewers independently appraised eligible articles identified through comprehensive searching and extracted data which were subjected to meta-analysis. RESULTS: Delays in TB diagnosis were associated with older age and low income [(OR = 1.49; 95% CI: 1.31-1.70) and (OR = 1.26; 95% CI: 1.09-1.45)] respectively (n = 17 studies). Being female was associated with patient delay and health system delay [(OR = 1.24; 95% CI: 1.02-1.50) and (OR = 1.68; 95% CI: 1.18-2.38)] respectively. Knowledge and perception of TB, having employment and low levels of crowding were each protective against patient delay. The GRADE system rated the evidence as of low quality. CONCLUSION: This review provides evidence for facilitators and barriers to TB diagnosis and health system delays. For successful TB control in the MENA region, TB awareness and interventions targeting the elderly and those from lower-income settings, particularly directed at gender differences, are essential.
Keywords:
Middle East and North Africa; Tuberculosis case finding; delayed diagnosis; delivery of health care; health care–seeking behaviour; tuberculosis control
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