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Title: Factors prolonging time period from onset of symptoms to start of treatment among smear positive tuberculosis patients in Sabah, East Malaysia
Author: Rundi, Christina
ISNI:       0000 0004 2678 996X
Awarding Body: London School of Hygiene & Tropical Medicine
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2008
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A third of the world's population (2,000 million people) is infected with tuberculosis (TB). The two main control measures emphasised by WHO are improved case detection and cure. rates. High case detection level is of great importance to decrease personal suffering, risk of death and limit transmission in the community. TB is also a social disease and aspect such as the patients' health seeking behaviour affect TB Control programme. According to WHO, Malaysia is a country with intermediate burden of TB but Sabah, in East Malaysia has a notification rate of two and a half times that of the country's and contributes one third of the total cases. Two studies were conducted in West Malaysia on delay among TB patients but none in East Malaysia. This research was conducted in 2 phases. Phase 1 utilised a qualitative approach to get a better understanding of the health seeking behaviour of TB patients and those involved in their care (32 respondents). Phase 2 was conducted among 296 newly registered smear positive TB patients using a pre-tested questionnaire. It was found that 51.8% (95% CI: 45.9 - 57.8) of patients sought treatment after 30 days and the median patient time period was 60 days. By using multivariate analysis, those whose u'sual first treatment choice was a non-government health facility were twice as likely to have patient delay than those whose usual first choice was a government facility (Adjusted OR: 2.28, CI: 1.03 - 5.06). The median for doctor time period was 20 days and almost 43% of the respondents were put on treatment within 14 days after consultation with a doctor. In the multivariate analysis for doctor delay, those Who had never used government facility, had chest pain and loss of weight were twice more likely to be associated with doctor delay. A repeat visit to the first provider was associated with an approximately 4 times greater risk of doctor delay than those who did not (AOR: 3.88, CI: 1.79 - 8.39). Recommendations for improvement of current public health practice include ensuring greater awareness and adherence to existing guidelines and coritinuous health education on TB. The findings on delay can be used to develop a Quality Assurance Programme (QAP) to shorten doctor delay.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral