Knowledge of symptoms and delays in diagnosis of extrapulmonary tuberculosis patients in North Shewa zone, Ethiopia.

Introduction: Delayed diagnosis contributes to the high burden and transmission of tuberculosis and extrapulmonary tuberculosis (EPTB) and continued to be a major public health problem in Ethiopia. Currently, there is insufficient knowledge on the contributing factors to diagnostic delay of EPTB patients in healthcare settings in Ethiopia, because of unique cultural and societal issues in this country. This study assessed patients' knowledge of symptoms and contributing factors of delay in diagnosis of EPTB patients at selected public health facilities in North Shewa zone, Ethiopia.

Methods: An institutional-based study was conducted from March to April 2021. All recently registered EPTB patients were included. Logistic regression was performed to analyze the data. A significant association was declared at a p-value of < 0.05, and the results were presented with an adjusted odds ratio (AOR) and the corresponding 95% confidence interval (CI).

Results: In this study, only 15.5% of respondents knew EPTB symptoms. The median patient and healthcare system delay was 55 days. A patient delay of greater than 3 weeks and a health system delay of greater than 2 weeks were observed among 85.2% and 81% of patients, respectively. After the end of 5 weeks, 87.3% of EPTB patients had been diagnosed with the disease and the total median delay was 108.5 days. Living more than ten kilometers far from a health facility (AOR = 1.54; 95% CI = 1.11, 4.63), having never heard of EPTB disease (AOR = 5.52; 95% CI = 1.73, 17.56), and having ever taken antibiotics at the first health facility visit (AOR = 7.62; 95% CI = 2.26, 25.65) were associated with a total diagnostic delay of beyond 5 weeks.

Conclusions: The diagnostic delays of EPTB remain high. Both patient and health system delays equally contributed to the total diagnosis delay. Improving community awareness of EPTB and advancing diagnostic efficiencies of healthcare facilities could help reduce both delays.