Global Burden of Delayed Care in Pulmonary Tuberculosis Cases: A Meta-analysis of Observational Studies from High Tuberculosis-burden Countries.

BACKGROUND

Delayed tuberculosis (TB) care can have adverse effects on both patients and the community. Such delays can perpetuate transmission within the community and disrupt ongoing efforts to eliminate TB.

OBJECTIVES

The primary objective of this meta-analysis was to estimate the pooled proportion of pulmonary TB (P-TB) cases experiencing delays in seeking care across high-burden countries worldwide.

MATERIALS AND

METHODS

Data extraction was conducted using three databases: PubMed, Scopus and DOAJ. This study was conducted as an extension of a scoping review, with the meta-analysis specifically aimed at estimating the pooled proportion of P-TB cases experiencing delays through quantitative data. The pooled proportion was calculated with a 95% confidence interval (CI) using a random-effects model, taking potential heterogeneity into account.

RESULTS

Thirty-two full-text articles, selected from 831 articles, were included in the meta-analysis, representing China, India, Myanmar, South Africa and Nigeria. The total sample used across all the studies was 184,242 with a mean (standard deviation [SD]) of 5758 (17,236) and (median - 491, interquartile range - 271-1563). The highest total sample was from China (n = 176,642), and the lowest total sample was from Nigeria (n = 160). The pooled proportion of P-TB cases experiencing delays in China, India, Myanmar, South Africa and Nigeria was 50% (95% CI: 41-59), 50% (95% CI: 36-63), 38% (95% CI: 3-82), 47% (95% CI: 37-56) and 42% (95% CI: 34-50), respectively. The overall global proportion was 48% (95% CI: 41-55), with significant heterogeneity (I2 = 99.85%) observed among the studies.

CONCLUSIONS

This study estimated that half of the global P-TB cases experienced delayed care, which is concerning and necessitates a multi-faceted approach to support TB elimination efforts.