عوامل موثر در تاخير تشخيص بيماري سل در شهرستان آبادان طي سال هاي 1389 تا 1392

The Factors Leading to Delayed Diagnosis of Tuberculosis in Abadan During 2010-2013

ﯾﮑﯽ از ﻋﻮاﻣﻞ ﻣﻮﺛﺮ در ﻋﺪم ﻣﻮﻓﻘﯿﺖ در ﻣﺒﺎرزه ﺑﺎ ﺑﯿﻤﺎري ﺳﻞ، ﺗﺎﺧﯿﺮدر ﺗﺸﺨﯿﺺ ﺑﯿﻤﺎري و ﺷﺮوع درﻣﺎن ﺑﻪ ﻣﻮﻗﻊ آن ﻣﯽ ﺑﺎﺷﺪ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺷﻨﺎﺳﺎﯾﯽ ﻋﻮاﻣﻞ ﻣﻮﺛﺮ در ﺗﺎﺧﯿﺮ ﺗﺸﺨﯿﺺ ﺑﯿﻤﺎري ﺳﻞ در ﺷﻬﺮﺳﺘﺎن آﺑﺎدان ﻃﯽ ﺳﺎلﻫﺎي 1389 ﺗﺎ 1392 اﻧﺠﺎم ﺷﺪ. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﮐﻮﻫﻮرت ﮔﺬﺷﺘﻪﻧﮕﺮ 367 ﺑﯿﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺷﻬﺮﺳﺘﺎن آﺑﺎدان وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ. ﺗﺎﺧﯿﺮ در ﺗﺸﺨﯿﺺ ﺷﺎﻣﻞ ﻓﺎﺻﻠﻪ زﻣﺎﻧﯽ از ﺷﺮوع ﻋﻼﺋﻢ ﺗﺎ زﻣﺎن ﺗﺸﺨﯿﺺ ﺑﻮد ﮐﻪ ﺑﺮاﺑﺮ و ﺑﯿﺸﺘﺮ از 3 ﻣﺎه در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﺟﻬﺖ ﺟﻤﻊ آوري اﻃﻼﻋﺎت از ﭼﮏ ﻟﯿﺴﺘﯽ ﺷﺎﻣﻞ: ﺟﻨﺴﯿﺖ، ﻣﺤﻞ ﺳﮑﻮﻧﺖ، ﮔﺮوه ﺳﻨﯽ و زﻣﺎن ﺗﺸﺨﯿﺺ و ﻫﻤﭽﻨﯿﻦ ﻣﺘﻐﯿﺮﻫﺎي ﺑﺎﻟﯿﻨﯽ ﺷﺎﻣﻞ ﻧﻮع ﺳﻞ، ﻧﺘﯿﺠﻪ آزﻣﺎﯾﺸﮕﺎﻫﯽ اﺳﻤﯿﺮ ﺧﻠﻂ ﺑﺪو درﻣﺎن، وﺿﻌﯿﺖ اﺑﺘﻼ ﺑﻪ HIV و ﮔﺮوه درﻣﺎﻧﯽ اﺳﺘﻔﺎده ﺷﺪ. ﺑﻪ ﻣﻨﻈﻮر ﺗﻌﯿﯿﻦ ارﺗﺒﺎط ﺑﯿﻦ ﻣﺘﻐﯿﺮﻫﺎي ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﺗﺎﺧﯿﺮ در ﺗﺸﺨﯿﺺ از آزﻣﻮن ﮐﺎي ﻣﺮﺑﻊ اﺳﺘﻔﺎده ﺷﺪ. داده ﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮم اﻓﺰار Stata ﻧﺴﺨﻪ 12، ﻣﻮرد ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. از ﻣﺠﻤﻮع 367 ﺑﯿﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ )250 (%68 ﻧﻔﺮ ﻣﺮد و )316 (%86/1 ﺑﯿﻤﺎر ﺳﺎﮐﻦ ﻣﻨﺎﻃﻖ ﺷﻬﺮي ﺑﻮدﻧﺪ. ﻣﺪت زﻣﺎن ﺗﺎﺧﯿﺮ در ﺗﺸﺨﯿﺺ ﺑﯿﻤﺎري در ﺑﯿﻦ ﻣﻨﺎﻃﻖ ﺷﻬﺮي و روﺳﺘﺎﯾﯽ اﺧﺘﻼف ﻣﻌﻨﺎداري داﺷﺖ )0/025=P( ﺑﻪ ﻧﺤﻮي ﮐﻪ در ﻣﻨﺎﻃﻖ روﺳﺘﺎﯾﯽ ﻧﺴﺒﺖ ﺑﻪ ﻣﻨﺎﻃﻖ ﺷﻬﺮي، ﺑﯿﻤﺎران ﺑﺎ ﺗﺎﺧﯿﺮ ﺷﻨﺎﺳﺎﯾﯽ ﺷﺪه ﺑﻮدﻧﺪ. ﺗﺎﺧﯿﺮ در ﺗﺸﺨﯿﺺ در ﻣﻮارد ﻣﺒﺘﻼ ﺑﻪ HIV ﻧﺴﺒﺖ ﺑﻪ ﺑﯿﻤﺎران ﻏﯿﺮ ﻣﺒﺘﻼ ﮐﻤﺘﺮ ﺑﻮد )0/04=P(. ﻣﯿﺎﻧﻪ ﺗﺎﺧﯿﺮ در ﺗﺸﺨﯿﺺ ﺑﯿﻤﺎران 2 ﻣﺎه ﺑﻮد. ﺗﺎﺧﯿﺮ ﺗﺸﺨﯿﺺ در ﺷﻨﺎﺳﺎﯾﯽ ﺑﯿﻤﺎري ﺳﻞ در ﻣﺮدان و در ﻣﻨﺎﻃﻖ روﺳﺘﺎﯾﯽ ﺑﯿﺸﺘﺮ ﺑﻮد. ﺑﻨﺎﺑﺮاﯾﻦ، ﺑﺎﯾﺴﺘﯽ ﺑﺮﻧﺎﻣﻪ ﻫﺎي ﺑﯿﻤﺎرﯾﺎﺑﯽ در ﺑﯿﻦ ﻣﺮدان و ﻫﻤﭽﻨﯿﻦ در ﻣﻨﺎﻃﻖ روﺳﺘﺎﯾﯽ ﺗﻘﻮﯾﺖ ﮔﺮدد.

Delay in diagnosis and timely beginning of treatment are among the effective factors on successful fight against tuberculosis. This study aimed to identify the factors leading to delayed diagnosis of tuberculosis in Abadan during 2010-2013. As a retrospective cohort study, 367 patients with tuberculosis were studied in Abadan. The delayed diagnosis was defined as the 3 month or higher interval from onset of symptoms until diagnosis. Data were collected by the prepared check list including gender, residence location, age group and time of diagnosis, together with the clinical variables including type of tuberculosis, sputum smear test result, HIV status and treatment groups. The chi-square test was applied to evaluate any relationship between variables and delay in diagnosis. Data were statistically analyzed by STATA version 12. Among the 367 enrolled tuberculosis patients, 250 (68%) were male and 316 (86.1%) participants were living in urban areas. Delayed diagnosis was significant different between the residence locations (p=0.025) i.e. delay in rural area was higher than urban areas. Furthermore delay in diagnosis of HIV positive cases was lower than HIV negative patients (p=0.025). Median of delay was 2 months. The delay in tuberculosis diagnosis was higher in men and in rural areas. Thus, patient screening programs should be strengthened, especially for men and rural areas.