Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis

Delay in diagnosis and initiation of effective treatment associated with an increase in morbidity, mortality, and ongoing person-to-person transmission in the community at large. Several studies have been conducted in Ethiopia; however, studies assessing the health system's delay in treating tuberculosis patients have yielded inconsistent and inconclusive results. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. We systematically searched different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus, and Springer link databases for studies published from June 6,1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using a random-effects model in R version 4.0.3 software (for median estimation) and Stata version 14 (for metan). A total of 14 studies with 6161 patients who met predetermined criteria were included. Our meta-analysis showed that the estimated pooled median time of the health system delay was 15.29 (95%CI: 9.94–20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015, the pooled median health system delay was 21.63 (95% CI: 14.38-28.88) days, whereas in studies conducted after 2015, the pooled median time was 9.33 (95% CI: 3.95-14.70) days. Living in rural areas (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. In Ethiopia, this review highlights that patients were delayed more than two weeks in the treatment of tuberculosis. Being a rural resident, was the contributing factor of health system delay. For successful TB control, implementing efforts like providing regular health education to the community about TB emphasizes the rural community and enhancing the quality of care in TB treatment facilities in rural areas could have important implications to reduce health system delay.