Abstract :

Delays in the treatment of Tuberculosis (TB) result in the failure to achieve the TB program’s goals. The delay in TB treatment can be measured by patient delay and healthcare service delay.This study aims to analyze the factors influencing the occurrence of patient delay in pulmonary tuberculosis. The type of this research is quantitative with a cross-sectional approach. The research population consists of all suspected Pulmonary TB patients, totaling 182 patients, with a sample of 158 respondents using the proportional random sampling technique. This research was conducted in the Working Area of Maja Public Health Center, Marga Punduh District, Pesawaran Regency, Lampung, Indonesia, in September-October 2024. Data collection was conducted using a questionnaire. Data analysis was conducted univariately (frequency distribution), bivariately (chi-square), and multivariately (logistic regression). The research results indicate that there are factors associated with the occurrence of patient delay in this study, namely age factor (p-value <0.001), gender (p-value = 0.017), employment status (p-value <0.001), economic status (p-value <0.001), education level (p-value = 0.003), knowledge level (p-value = 0.023), smoking history (p-value = 0.022), distance from residence (p-value = 0.040), and cadre support (p-value <0.001). The dominant factor influencing the occurrence of patient delay in tuberculosis treatment is the employment factor (p-value = 0.019; OR (95% CI) = 21.5 (1.67-279.24). Advice for healthcare workers includes providing education about TB, particularly the cough symptoms suspected to be TB, especially in the smoking community, and efforts to change patients’ perceptions about TB are essential to reduce the level of delay in seeking early healthcare.

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Keywords :

Cross Sectional Study, Indonesia, Patient delay, Public Health Center, Tuberculosis

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References :

1. Abdul, J. B. P. A. A., Adegbite, B. R., Ndanga, M. E. D., Edoa, J. R., Mevyann, R. C., Mfoumbi, G. R. A. I., de Dieu, T. J., Mahoumbou, J., Biyogho, C. M., Jeyaraj, S., Niemann, S., Lell, B., Kremsner, P. G., Alabi, A. S., Adegnika, A. A., & Grobusch, M. P. (2023). Resistance patterns among drug-resistant tuberculosis patients and trends-over-time analysis of national surveillance data in Gabon, Central Africa. Infection, 51(3), 697–704. https://doi.org/10.1007/s15010-022-01941-5
2. Andersen, R., & Newman, J. F. (1973). Societal and Individual Determinants of Medical Care Utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society, 51, 95-124. https://doi.org/10.2307/3349613
3. Bandura, A. (1986). Social Foundations of Thought and Theory: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall.
4. Bourdieu, P. (1986). The Forms of Capital. In J. Richardson (Ed.), Handbook of Theory and Research for the Sociology of Education
5. Buregyeye, E. 2014. Delays in Diagnosis and Treatment of Pulmonary Tubercuosis in Wakiso and Mukono Districts, Uganda. BMC Public Health
6. Gakidou, Emmanuela et al. (2017). Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, Volume 390, Issue 10100, 1345 – 1422
7. Green, L. and Kreuter, M. (2005) Health program planning An educational and ecological approach. 4th Edition, McGraw Hill, New York.
8. Huong, dkk. 2007. Delays in the diagnosis and treatment of tuberculosis patients in Vietnam: a cross-sectional study. BMC Public Health, 7 (110), 1-8
9. Islamiyah F. (2015). Karakteristik dan Alasan Patient Delay pada Kasus TB BTA (+) di Wilayah Kerja Puskesmas Kecamatan Kramat Jati Jakarta Timur Tahun 2014. Skripsi. Universitas Islam Negeri Syarif Hidayatullah. Jakarta.
10. Jianming Wang, Yang Fei, Hongbing Shen, Xu B. (2008). Gender difference in knowledge of tuberculosis and associated health-care seeking behaviors: a cross-sectional study in a rural area of China. BMC Public Health. 8 (354):1-7.
11. Konda S, Melo C, Giri P, Behera A (2014). Determinants of delays in diagnosis and treatment of pulmonary tuberculosis in a new urban township in India: A cross-sectional study. Int J Med Sci Public Health. 3(2): 140. doi: 10.5455/ijmsph.2013.011120131.
12. Kementerian Kesehatan RI. (2020). Strategi Nasional Penanggulangan Tuberkulosis di Indonesia. Jakarta: Kementerian Kesehatan
13. Maryoto, M., & Khasanah, S. (2021). Hubungan Usia dan Pendidikan dengan Keterlambatan Pencarian Pengobatan Pasien Tuberkulosis Paru di Kabupaten Banyumas. Viva Medika, 14(02), 220-227.
14. Mekonen et al.., Delay for First Consultation and Associated Factors among Tuberculosis Patients in Bahir Dar Town Administration, North West Ethiopia. American Journal of Health Research. 2 (4), 140-5.
15. Marmot, M. G. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099–1104. https://doi.org/10.1016/S0140-6736(05)71146-6
16. Orazulike, N., Sharma, J. B., Sharma, S., & Umeora, O. U. J. (2021). Tuberculosis (TB) in pregnancy – A review. European journal of obstetrics, gynecology, and reproductive biology, 259, 167–177. https://doi.org/10.1016/j.ejogrb.2021.02.016.
17. Penchansky, R., & Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care, 19(2), 127–140. https://doi.org/10.1097/00005650-198102000-00001Ratnasari Nita Yunianti, Marni. Peran Kader Kesehatan dalam Pencegahan Kejadian Tuberkulosis di Wonogiri, Volume 11 Nomor 1, Januari 2020
18. Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403
19. Widiastuti, N., Dwianto, W., & Sari, R. (2020). The influence of job characteristics on health seeking behavior in tuberculosis patients. Journal of Public Health and Community Medicine, 12(2), 91-98. https://doi.org/10.1007/jphcm.2020.14.2.91
20. World Health Organization. (2006). Diagnostic and Treatment Delay in Tuberculosis. WHO.
21. World Health Organization. (2018). Global tuberculosis report 2018. World Health Organization. https://iris.who.int/handle/10665/274453.
22. Xia D, Zhang Z, Li X, Jiang C, Ma J, Ding S, Chen B, Guo R, Wen Y. (2016). Factors Associated with Patient Delay Among New Tuberculosis Patient in Anqing, China. Biomedical Research. 27(3):651-8.