Volume 32, Issue 2 (Avicenna Journal of Clinical Medicine-Summer 2025)
Avicenna J Clin Med 2025, 32(2): 109-117 |
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Yazdanian Z, Moslehi S, Mohammadi Y, Torkman Asadi F, Khazaei S. Determinants of Delayed Diagnosis in Smear-Positive Pulmonary Tuberculosis Patients in Hamadan Province, Iran (2011-2022). Avicenna J Clin Med 2025; 32 (2) :109-117
URL: http://sjh.umsha.ac.ir/article-1-3247-en.html
URL: http://sjh.umsha.ac.ir/article-1-3247-en.html
1- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran & Department of Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
2- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Center, Institute of
3- Department of Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran & Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
4- Infectious Disease Research Center, Avicenna Institute of Clinical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran & Department of Infectious Diseases, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
5- Department of Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran & Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran ,salman.khazaei61@gmail.com
2- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Center, Institute of
3- Department of Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran & Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
4- Infectious Disease Research Center, Avicenna Institute of Clinical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran & Department of Infectious Diseases, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
5- Department of Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran & Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran ,
Abstract: (101 Views)
Background and Objective: Early diagnosis of smear-positive pulmonary tuberculosis (TB) is essential for reducing disease transmission and improving treatment outcomes. Despite advances in TB control, delayed diagnosis remains a significant challenge in many regions, including Iran. This study aims to identify the determinants of delayed diagnosis among smear-positive pulmonary TB patients in Hamadan province, Iran.
Materials and Methods: This descriptive-analytical cross-sectional study included all smear-positive pulmonary TB patients registered in the Hamadan province communicable disease surveillance system between 2011 and 2022. Delay in diagnosis was defined as the interval between symptom onset and confirmed diagnosis. Ordinal logistic regression was used to identify factors associated with higher smear grades, which were considered a proxy for diagnostic delay. Survival analysis was performed using the Kaplan-Meier method and the log-rank test.
Results: A total of 460 smear-positive pulmonary TB patients were included (mean age=39.6 years; 54.6% male; 62.2% urban residents). The mean diagnostic delay was 50.9 days (SD= 131.7). The majority of patients were new cases (90.02%), and the most common smear grade at diagnosis was 3+ (43.5%). Ordinal logistic regression showed that younger age, negative HIV status, and being a new TB case were significantly associated with higher smear grades at diagnosis, indicating greater diagnostic delay (P<0.05).
Conclusion: The findings highlight a substantial delay in the diagnosis of smear-positive pulmonary TB in Hamadan province, particularly among younger, HIV-negative, and newly diagnosed patients. Targeted interventions, such as enhanced provider and patient education, active case finding, and the strengthening of public-private partnerships, are recommended to reduce diagnostic delays and improve TB control outcomes in the region.
Materials and Methods: This descriptive-analytical cross-sectional study included all smear-positive pulmonary TB patients registered in the Hamadan province communicable disease surveillance system between 2011 and 2022. Delay in diagnosis was defined as the interval between symptom onset and confirmed diagnosis. Ordinal logistic regression was used to identify factors associated with higher smear grades, which were considered a proxy for diagnostic delay. Survival analysis was performed using the Kaplan-Meier method and the log-rank test.
Results: A total of 460 smear-positive pulmonary TB patients were included (mean age=39.6 years; 54.6% male; 62.2% urban residents). The mean diagnostic delay was 50.9 days (SD= 131.7). The majority of patients were new cases (90.02%), and the most common smear grade at diagnosis was 3+ (43.5%). Ordinal logistic regression showed that younger age, negative HIV status, and being a new TB case were significantly associated with higher smear grades at diagnosis, indicating greater diagnostic delay (P<0.05).
Conclusion: The findings highlight a substantial delay in the diagnosis of smear-positive pulmonary TB in Hamadan province, particularly among younger, HIV-negative, and newly diagnosed patients. Targeted interventions, such as enhanced provider and patient education, active case finding, and the strengthening of public-private partnerships, are recommended to reduce diagnostic delays and improve TB control outcomes in the region.
Type of Study: Original |
Subject:
Biostatistics & Epidemiology
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