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.