Abstract
Introduction: Tuberculosis (TB) affects approximately a quarter of the world's population and causes a significant burden on healthcare systems in developed and developing countries. Worldwide, TB caused an estimated 10 million cases in 2019, with the majority of cases occurring in Southeast Asia (SEA) (44%), Africa (25%) and the Western Pacific (18%). It is reported that early detection and treatment saved approximately 37 million lives between 2000 and 2013. Hence, prompt detection and treatment are essential to improve clinical outcomes and reduce risk of transmission. However, delayed health-seeking behaviours significantly increase treatment failure and the risk of community transmission, leading to mortality. Nonetheless, there is a dearth of information published on delays in tuberculosis healthcare in Malaysia and the social epidemiology (sociodemographic, socioeconomic, and sociocultural determinants). Therefore, this review aims to summarise the literature on delayed healthcare and the social determinants in Malaysia.
Methods: A literature search was conducted among the Pubmed, Medline, SCOPUS, Web of Science and Google Scholar databases using tuberculosis, TB, social epidemiology, delay, pulmonary TB, and Malaysia as keywords. Papers published between 1990 and 2020, with varying study designs, duration and definitions of delays, were included in the review. The results were tabulated, and descriptive statistics such as frequencies were used to summarise the data.
Results: The literature search yielded seven local papers published between 1990 and 2020 which reported on delays. The median patient delay ranged from 14 - 30 days, median diagnostic delay ranged from 21- 49 days, and median treatment delay ranged from 0 - 30 days. The social epidemiological factors influencing delays included sociodemographic factors such as male gender and age; socioeconomic factors such as employment, education, transport, and housing; healthcare facilities and providers first sought; and sociocultural and behavioural factors included smoking and TB stigma. Discussion: This is the first review of literatures on the social determinants affecting healthcare delays among tuberculosis patients in Malaysia. The Malaysian public and healthcare providers need to be educated on the symptoms, the importance of early diagnosis and the social barriers which cause delays in tuberculosis diagnosis and treatment to reduce its spread. A more targeted strategies on the social factors contributing to delayed presentation need to be addressed to significantly reduce the incidence of TB in Malaysia and fulfil the Sustainable Development Goals. Furthermore, a comprehensive study is needed on the social determinants impacting delays in TB healthcare within the districts of Malaysia, incorporating suitable sample sizes of participants and unified definitions of delays.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-106.pdf
- https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed1909[...]
BibTeX (Download)
@proceedings{APCPH2022-P-106,
title = {Social determinants causing healthcare delays among TB patients in Malaysia: Are we in a dilemma?},
author = {Punitha Makeswaran and Shamsul Azhar Shah},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-106.pdf
https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed19095a89ed/APCPH2022-P-106-aa01221d9183c471035a012cfb7ea0f2.pdf},
year = {2022},
date = {2022-08-02},
urldate = {2022-08-02},
issue = {7},
abstract = {Introduction: Tuberculosis (TB) affects approximately a quarter of the world's population and causes a significant burden on healthcare systems in developed and developing countries. Worldwide, TB caused an estimated 10 million cases in 2019, with the majority of cases occurring in Southeast Asia (SEA) (44%), Africa (25%) and the Western Pacific (18%). It is reported that early detection and treatment saved approximately 37 million lives between 2000 and 2013. Hence, prompt detection and treatment are essential to improve clinical outcomes and reduce risk of transmission. However, delayed health-seeking behaviours significantly increase treatment failure and the risk of community transmission, leading to mortality. Nonetheless, there is a dearth of information published on delays in tuberculosis healthcare in Malaysia and the social epidemiology (sociodemographic, socioeconomic, and sociocultural determinants). Therefore, this review aims to summarise the literature on delayed healthcare and the social determinants in Malaysia.
Methods: A literature search was conducted among the Pubmed, Medline, SCOPUS, Web of Science and Google Scholar databases using tuberculosis, TB, social epidemiology, delay, pulmonary TB, and Malaysia as keywords. Papers published between 1990 and 2020, with varying study designs, duration and definitions of delays, were included in the review. The results were tabulated, and descriptive statistics such as frequencies were used to summarise the data.
Results: The literature search yielded seven local papers published between 1990 and 2020 which reported on delays. The median patient delay ranged from 14 - 30 days, median diagnostic delay ranged from 21- 49 days, and median treatment delay ranged from 0 - 30 days. The social epidemiological factors influencing delays included sociodemographic factors such as male gender and age; socioeconomic factors such as employment, education, transport, and housing; healthcare facilities and providers first sought; and sociocultural and behavioural factors included smoking and TB stigma. Discussion: This is the first review of literatures on the social determinants affecting healthcare delays among tuberculosis patients in Malaysia. The Malaysian public and healthcare providers need to be educated on the symptoms, the importance of early diagnosis and the social barriers which cause delays in tuberculosis diagnosis and treatment to reduce its spread. A more targeted strategies on the social factors contributing to delayed presentation need to be addressed to significantly reduce the incidence of TB in Malaysia and fulfil the Sustainable Development Goals. Furthermore, a comprehensive study is needed on the social determinants impacting delays in TB healthcare within the districts of Malaysia, incorporating suitable sample sizes of participants and unified definitions of delays.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: POSTER PRESENTATION; Organisation: Department of Community Medicine, UKM Medical Centre, Cheras, Kuala Lumpur, Malaysia},
keywords = {delay, diagnosis, health-seeking behaviour, Social determinants, TB, treatment., tuberculosis},
pubstate = {published},
tppubtype = {proceedings}
}