Determinants of Delayed Diagnosis and Multi-Drug Resistent Tuberculosis Treatment in Surakarta, Central Java


Paulus Wisnu K, Yusup Subagio Sutanto,

Ari Natalia Probandari, Reviono

 

Department of Pulmonology and Respiratory Medicine,

Faculty of Medicine, Dr. Moewardi Hospital, Surakarta

 

ABSTRACT

Background: Tuberculosis (TB) is a leading cause of morbidity and mortality world­­wide, accounting for about 9.6 million new cases and 1.5 million deaths annually. Multidrug resistant tuberculosis (MDR-TB), defined as resistance to, at le­ast, rifampin and isoniazid (the recommended first-line therapeutic regimen), rep­re­sents another important threat in the fight against the dise­a­se. Approximately 480,000 newly emerging cases of MDR-TB are estimated to oc­­cur every year. The spre­ad of MDR-TB mostly derives from mismanagement of TB cases such as the use of inappropriate dosage, inappropriate regimen, limited avai­lability of quality assured pharmaceutical products, and little effort to sup­port patient adheren­ce. This study aimed to examine the determinants of delayed MDR-TB diagnosis and treatment in Surakarta, Central Java.

Subjects and Method: This was a cross sectional study conducted at Dr. Moewar­di Hospital, Surakarta, Central Java. A total of 73 MDR-TB patients were se­lec­ted for this study. The dependent variable was delayed MDR-TB diagnosis and treat­ment. The independent variables were age, gender, distance to health faci­li­ty, health facility type, suspect criteria of MDR-TB. Data on MDR-TB were taken from medical record. The other data were collected by questionnaire and analy­zed by a multiple logistic regression.

Results: Delayed MDR-TB diagnosis was associated with age (OR= 1.02; 95% CI= 0.98 to 1.06; p= 0.330), gender (OR= 0.06; 95% CI= 0.19 to 1.75 p= 0.330), dis­tance to health facility (OR=1.50; 95% CI= 0.53 to 4.19; p= 0.450), health fa­ci­lity type (OR= 0.97; 95% CI= 0.49 to 1.92; p= 0.920), and MDR-TB suspect cri­te­ria (OR= 0.91;  95% CI= 0.61 to 1.35; p= 0.620), but none of them was sta­tis­tical­ly significant. Delayed MDR-TB treatment was associated with age (OR= 0.99; 95% CI= 0.96 to 1.03; p= 0.870), gender (OR= 0.42; 95% CI= 0.15 to 1.22; p= 0.112), distance to health facility (OR= 1.2; 95% CI= 0.44 to 3.30; p= 0.730), health facility type (OR= 1.50; 95% CI= 0.77 to 2.92; p= 0.240), and MDR-TB sus­pect criteria (OR= 0.90; 95% CI= 0.62 to 1.32; p= 0.600), but none of them was statistically significant.

Conclusion: Age, gender, distance to health facility, health facility type, and MDR-TB suspect criteria, can not be used as reliable predictors of delayed MDR-TB diagnosis and treatment.

Keywords: delayed, diagnosis, treatment, multidrug resistant tuberculosis.

Correspondence: Paulus Wisnu K. Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Dr. Moewardi Hospital, Surakarta, Cen­tral Java. Email: wisnukuncoro954@gmail.com. Mobile: 085200691859

DOI: https://doi.org/10.26911/theicph.2018.01.70

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