Factors Associated with Diagnostic Delay of Pulmonary Tuberculosis Among Children and Adolescents in Quzhou, China: Results from the Surveillance Data 2011-2021

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2023 Aug 18

PMID 37596514

Authors

Yating Zhang

Bingdong Zhan

Xiaogang Hao

Wei Wang

Xing Zhang

Chunfu Fang

Min Wang

Affiliations

Soon will be listed here.

Abstract

Purpose: Tuberculosis is a high-burden disease and a major health concern in China, especially among children and adolescents. The purpose of this study was to assess risk factors for diagnostic delay in students with pulmonary tuberculosis in Quzhou City in eastern China.

Patients And Methods: Cases of PTB in students and relevant information in Quzhou from 2011 to 2021 were collected using the TB Management Information System. The outcome of interest was diagnostic delay (i.e. ≥ 28 days between symptom onset and treatment initiation). Risk factors for diagnostic delay were identified using multivariable logistic regression.

Results: A total of 629 students in Quzhou were diagnosed with PTB during the study period, of whom 55.5% were male. The median diagnostic delay was 18 days (Inter Quartile Range, [IQR]: 8-38) and 38.0% of the students had a diagnostic delay. Living in a rural area (adjusted odds ratio, [AOR]: 1.56, 95% confidence interval [CI:] 1.11-2.19), developing PTB symptoms in the first quarter of the year (AOR: 2.18, 95% CI: 1.40-3.40), and no sputum smear result (AOR: 8.73, 95% CI: 1.68-45.30) were significantly associated with a diagnostic delay. Discovery through health examinations (AOR: 0.33, 95% CI: 0.17-0.63) was associated with reduced risk of diagnostic delay.

Conclusion: Schools in rural areas should pay special attention to increasing student awareness of the symptoms of tuberculosis and provide health education on tuberculosis prevention and control to students and staff.

Citing Articles

Impact of integrating traditional care with the modern healthcare system in reducing tuberculosis diagnosis delays in Ethiopia: a clustered randomized controlled study.

Amare D, Alene K, Ambaw F Trop Med Health. 2024; 52(1):83.

PMID: 39533424 PMC: 11558963. DOI: 10.1186/s41182-024-00641-0.

Epidemiological Characteristics and Spatiotemporal Clustering of Pulmonary Tuberculosis Among Students in Southwest China From 2016 to 2022: Analysis of Population-Based Surveillance Data.

Kong D, Wu C, Cui Y, Fan J, Zhang T, Zhong J JMIR Public Health Surveill. 2024; 10:e64286.

PMID: 39319617 PMC: 11462631. DOI: 10.2196/64286.

Epidemiological characteristics and influencing factors of tuberculosis aggregation in schools in Wuhan, China during 2017-2022.

Zhang Z, Wu G, Yu A, Hu J, Zhang W, Lu Z Front Public Health. 2024; 12:1365983.

PMID: 38894992 PMC: 11183800. DOI: 10.3389/fpubh.2024.1365983.

References

Rajbhandary S, Marks S, Bock N . Costs of patients hospitalized for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2004; 8(8):1012-6. PMC: 5451103. View

Yang Y, Li X, Zhou F, Jin Q, Gao L . Prevalence of drug-resistant tuberculosis in mainland China: systematic review and meta-analysis. PLoS One. 2011; 6(6):e20343. PMC: 3108589. DOI: 10.1371/journal.pone.0020343. View

Cheong K, Mohd Ghazali S, Md Zamri A, Cheong Y, Iderus N, Nagalingam T . Gender Differences in Factors Associated with the Total Delay in Treatment of Pulmonary Tuberculosis Patients: A Cross-Sectional Study in Selangor, Malaysia. Int J Environ Res Public Health. 2022; 19(10). PMC: 9140698. DOI: 10.3390/ijerph19106258. View

Xia Y, Chen H, Zhang C, Zhao Y, Cheng J, Zhang H . Guidelines for the Prevention and Control of Tuberculosis in Schools: Recommendations from China CDC. China CDC Wkly. 2021; 3(2):34-38. PMC: 8392894. DOI: 10.46234/ccdcw2021.009. View

You S, Tong Y, Neoh K, Dai Y, Wang C . On the association between outdoor PM concentration and the seasonality of tuberculosis for Beijing and Hong Kong. Environ Pollut. 2016; 218:1170-1179. DOI: 10.1016/j.envpol.2016.08.071. View

Bogale S, Diro E, Shiferaw A, Yenit M . Factors associated with the length of delay with tuberculosis diagnosis and treatment among adult tuberculosis patients attending at public health facilities in Gondar town, Northwest, Ethiopia. BMC Infect Dis. 2017; 17(1):145. PMC: 5307798. DOI: 10.1186/s12879-017-2240-0. View

Farah M, Rygh J, Steen T, Selmer R, Heldal E, Bjune G . Patient and health care system delays in the start of tuberculosis treatment in Norway. BMC Infect Dis. 2006; 6:33. PMC: 1435913. DOI: 10.1186/1471-2334-6-33. View

Li Y, Ehiri J, Tang S, Li D, Bian Y, Lin H . Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis. BMC Med. 2013; 11:156. PMC: 3699418. DOI: 10.1186/1741-7015-11-156. View

Lin Y, Enarson D, Chiang C, Rusen I, Qiu L, Kan X . Patient delay in the diagnosis and treatment of tuberculosis in China: findings of case detection projects. Public Health Action. 2015; 5(1):65-9. PMC: 4525372. DOI: 10.5588/pha.14.0066. View

10.

Liu J, Yao H, Liu E . Analysis of factors affecting the epidemiology of tuberculosis in China. Int J Tuberc Lung Dis. 2005; 9(4):450-4. View

11.

Willis M, Winston C, Heilig C, Cain K, Walter N, Mac Kenzie W . Seasonality of tuberculosis in the United States, 1993-2008. Clin Infect Dis. 2012; 54(11):1553-60. PMC: 4867465. DOI: 10.1093/cid/cis235. View

12.

Hou J, Pang Y, Yang X, Chen T, Yang H, Yang R . Outbreak of Beijing Strain in a High School in Yunnan, China. Am J Trop Med Hyg. 2020; 102(4):728-730. PMC: 7124909. DOI: 10.4269/ajtmh.19-0533. View

13.

Naranbat N, Nymadawa P, Schopfer K, Rieder H . Seasonality of tuberculosis in an Eastern-Asian country with an extreme continental climate. Eur Respir J. 2009; 34(4):921-5. DOI: 10.1183/09031936.00035309. View

14.

Bagcchi S . WHO's Global Tuberculosis Report 2022. Lancet Microbe. 2022; 4(1):e20. DOI: 10.1016/S2666-5247(22)00359-7. View

15.

Li T, Cheng Q, Li C, Stokes E, Collender P, Ohringer A . Evidence for heterogeneity in China's progress against pulmonary tuberculosis: uneven reductions in a major center of ongoing transmission, 2005-2017. BMC Infect Dis. 2019; 19(1):615. PMC: 6626433. DOI: 10.1186/s12879-019-4262-2. View

16.

SHERMAN L, Fujiwara P, Cook S, Bazerman L, Frieden T . Patient and health care system delays in the diagnosis and treatment of tuberculosis. Int J Tuberc Lung Dis. 1999; 3(12):1088-95. View

17.

Tupasi T, Gupta R, Quelapio M, Orillaza R, Mira N, Mangubat N . Feasibility and cost-effectiveness of treating multidrug-resistant tuberculosis: a cohort study in the Philippines. PLoS Med. 2006; 3(9):e352. PMC: 1564168. DOI: 10.1371/journal.pmed.0030352. View

18.

Guo C, Du Y, Shen S, Lao X, Qian J, Ou C . Spatiotemporal analysis of tuberculosis incidence and its associated factors in mainland China. Epidemiol Infect. 2017; 145(12):2510-2519. PMC: 9148796. DOI: 10.1017/S0950268817001133. View

19.

Gebeyehu E, Azage M, Abeje G . Factors associated with patient's delay in tuberculosis treatment in Bahir Dar City administration, Northwest Ethiopia. Biomed Res Int. 2014; 2014:701429. PMC: 4055020. DOI: 10.1155/2014/701429. View

20.

Lusignani L, Quaglio G, Atzori A, Nsuka J, Grainger R, Palma M . Factors associated with patient and health care system delay in diagnosis for tuberculosis in the province of Luanda, Angola. BMC Infect Dis. 2013; 13:168. PMC: 3637285. DOI: 10.1186/1471-2334-13-168. View