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Table 3 Factors associated with Health system delays in accessing TB treatment services

From: Tuberculosis treatment delays and associated factors within the Zimbabwe national tuberculosis programme

Characteristic (N = 383)   Health system delay > 4 days*
  n (%) OR (95% CI) Adjusted OR (95% CI)
Age in years    
 18 – 25 9 (17.3) Reference Reference
 26 – 44 84 (34.4) 2.51 (1.08-5.84) 3.30 (1.16-9.37)
 45 – 54 18 (32.4) 2.30 (0.85-6.22) 3.57 (1.09-11.72)
 ≥55 7 (20.9) 1.26 (0.38-4.18) 2.66 (0.61-11.57)
Type of diagnostic test    
 Direct smear microscopy 110 (30.4) Reference Reference
 Gene Xpert 7 (35.6) 1.27 (0.56-2.85) 0.21 (0.07-0.66)
Sex    
 Female 61 (35.6) Reference Reference
 Male 56 (26.6) 0.66 (0.41-1.06) 0.47 (0.23-0.96)
Type of health facility    
 District/mission hospital 48 (20.5) Reference Reference
 Provincial hospital 12 (64.6) 7.08 (2.81-17.88) 14.15 (4.58-43.69)
 Urban municipal 37 (50.1) 3.89 (2.21-6.86) 6.9 (2.41-19.82)
 Rural primary healthcare facility 21 (37.6) 2.33 (1.19-4.58) 2.67 (1.18-6.07)
TB Diagnosing centre on site    
 Yes 71 (25.5) Reference Reference
 No 43 (45.8) 2.48 (1.53-4.02) 1.41 (0.59-3.36)
HIV status    
 Not tested 2 (33.5) Reference Reference
 HIV-negative 38 (27.0) 0.73 (0.13-4.11) 0.72 (0.06-8.97)
 HIV-positive, not yet on ART 20 (28.0) 0.77 (0.13-4.52) 0.70 (0.06-8.99)
 HIV-positive, on ART/CPT 55 (34.5) 1.04 (0.19-5.78) 1.37 (0.11-17.04)
Residence    
 Urban 43 (37.6) Reference Reference
 Rural 74 (27.9) 0.81 (0.54-1.22) 0.95 (0.71-1.29)
History of smoking    
 Never 80 (29.9) Reference Reference
 Current smoker 7 (25.1) 0.79 (0.29-2.14) 1.58 (0.45-5.63)
 Quit smoking 29 (34.2) 1.22 (0.70-2.12) 0.86 (0.39-1.89)
History of alcohol use    
 Never 64 (30.1) Reference Reference
 Current drinker 5 (18.6) 0.53 (0.20-1.37) 0.40 (0.11-1.42)
 Quit alcohol use 46 (34.7) 1.23 (0.74-2.05) 1.50 (0.69-3.26)
Took traditional medicine    
 No 109 (31.3) Reference Reference
 Yes 9 (24.6) 0.72 (0.31-1.65) 0.66 (0.28-1.57)
Took self-medication from pharmacy    
 No 98 (29.2) Reference Reference
 Yes 20 (41.3) 1.71 (0.90-3.23) 1.68 (0.72-3.93)
Health care visits prior to diagnosis    
 1 46 (26.8) Reference Reference
 2 40 (33.5) 1.38 (0.79-2.41) 1.82 (0.93-3.53)
 3 10 (25.2) 0.92 (0.39-2.15) 0.99 (0.33-2.96)
 ≥4 20 (43.9) 2.14 (1.06-4.34) 2.24 (1.02-4.94)
Time taken to reach health facility    
 <30 minutes 52 (34.3) Reference Reference
 30mins - 1 hour 33 (33.1) 0.95 (0.52-1.71) 1.38 (0.65-2.93)
 >1 hour 32 (25.4) 0.65 (0.37-1.15) 1.03 (0.46-2.27)
Distance to health facility (in km)    
 ≤5 44 (36.4) Reference Reference
 6 – 15 17 (26.7) 0.64 (0.32-1.27) 0.78 (0.32-1.88)
 16 – 30 18 (32.9) 0.86 (0.41-1.78) 1.84 (0.68-4.98)
 ≥30 15 (16.5) 0.35 (0.16-0.75) 0.51 (0.20-1.29)
Difficulty in accessing transport to health centre    
 No 21 (32.6) Reference Reference
 Yes 96 (30.3) 1.14 (0.60-2.19) 1.00 (0.64-1.57)
Total 118 (30.7) - -
  1. *Health system delay was defined as a period >4 days from first encounter with health worker to date of starting TB treatment.
  2. DOT = directly observed treatment; HIV = human immunodeficiency virus; CPT = cotrimoxazole preventive therapy; ART = antiretroviral therapy; TB = tuberculosis, VCT = voluntary counseling and testing.
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