Factors Associated with Delays Affecting Health Care Servicein Commencement of Tuberculosis Treatment in Kwale County, Kenya

Abstract

Introduction: Tuberculosis (TB) is a communicable disease, a major cause of ill health and one of the top 10 causes of death worldwide. In 2018, an estimated 10 million people fell ill from TB with 1.5 million mortalities globally. Those were 5.7 million men, 3.2 million women and 1.1 million children. The prevalence of TB in Kenya was 558 per 100,000 adults an increase from the 2015 prevalence of 233/100,000. The highest disease burden was reported among people aged 25–34 years, males and those who lived in urban areas. Delay in treatment not only increased the risk of transmitting the infection but also led to an increase of multi drug resistant (MTR) TB. Nearly half of all estimated TB cases in Kwale County in Kenya had not been diagnosed, notified nor treated. Among children with TB, nearly two-thirds had not been diagnosed and approximately 80% of people with drug-resistant TB were neglected [6,8]

Objectives : This study sought to establish health care service-related factors associated with delay in commencement of ant-TB drugs provision to TB patients in Kwale County, Kenya.

Methodology:  This was an exploratory qualitative study. Data was collected from health care workers at the Ministry of Health, Kwale County. Key informants were purposively sampled based on staffing listing and departments. This yielded a total of 14 key informants to be interviewed. Data was collected until saturation, transcribed and analyzed using framework and thematic analysis methods.

Results:  There existed barriers in provision of quality health care services in Kwale. Delays in treatment of TB not only increased the risk of transmitting the infection to healthy people but also led to an increase of multi drug resistance TB. Delay that was constituted by; elapsed time between onset of TB symptoms and first self-presentation to a formal health care facility, between first presentation to formal care and anti-TB treatment initiation. confirmed total delays as time elapsed between onset of TB symptoms, diagnosis and anti-TB treatment initiation.

Conclusion: Based on the three themes that emerged from the data analysis, health care service-related factors associated with delay in commencement of TB treatment in Kwale County were lack of diagnostic machines, poor TB surveillance systems, and poor road transport network.

Recommendation:  We recommend The County Government of Kwale to invest in GeneXpert MTB/RIF diagnostic machines, strengthen TB surveillance system by involving Community Health Workers (CHWs) and improve the road network in every Sub- County. That would help reduce the burden of TB in the region, Kenya and the rest of the world.

Key Words: Tuberculosis, TB treatment delay, Health Service-Related Factors, Kwale County