Delays in diagnosis and treatment of pulmonary tuberculosis, and patient care-seeking pathways in China: a systematic review and meta-analysis
Notice bibliographique
Résumé
BACKGROUND: Early diagnosis and treatment is a cornerstone of the effective control of tuberculosis (TB), both in China and elsewhere. OBJECTIVES: To undertake a systematic review of the delay between the onset of TB symptoms and initiation of appropriate treatment, based on existing studies, and to summarize available information on patients' care-seeking behavior and the pathways to treatment in China. METHODS: A systematic review and meta-analysis was performed. PubMed, EMBASE, the Web of Science and the China National Knowledge Infrastructure (CNKI) databases were searched to identify relevant studies. Study selection, data extraction and quality assessment were undertaken by two independent reviewers. The median length and interquartile range (IQR) of the median delays reported by the primary studies were summarized. In addition, further estimates were made of the mean delay and variation of delay at an individual study level, based on known medians, sample sizes, and the IQR/range for each case. These results were used to pool the delay duration using a random effects mode. Finally, to meta-analyze care-seeking behaviors, a random effects model was deployed, using exact binomial likelihood. The review was reported according to the PRISMA standards. Subgroup analyses were conducted of data from different regions of China, urbanization level, and type of TB.RESULTS: A total of 94 studies were included in the final analysis. The median of length of the reported patient delay was 18 days (IQR = 10 to 23 days) and the pooled mean was 18.4 days (95% CI = 11.8 to 25 days, I2=0). The median length of diagnostic delay was 11 days (IQR = 5 to 24 days) with a pooled mean of 8.8 days (95% CI = 3.6 to 13.9 days, I2=19.8%). The figures for the median and pooled mean of total delay were 55.5 days (IQR = 43.8 to 64.3 days) and 52.5 days respectively (95% CI = -6.5 to 111.4 days, I2=0). There was significant variation identified in treatment patterns across China. The total patient delay in western China (85.2 days, 95% CI=23.8 to 146.7 days) was substantially longer than that in eastern China (17.4 days, 95% CI=10.4 to 24.4 days). Of the 64 studies that reported care-seeking behavior, 23 indicated that village clinics were used for initial health consultations and 36 indicated that general hospitals (county level and above) were the initial contact points. Importantly, 82.7% of patients, who initially sought care in general hospitals, were referred directly to TB dispensaries (95% CI = 51.2 to 95.6%), whereas the percentage was only 14.3% among patients who initially sought care in village clinics (95% CI = 6.1 to 63.2%). Overall, people who initially sought care in village clinics had a more complex route to take, before ultimate referral to TB dispensaries, visiting more healthcare providers. CONCLUSIONS: The findings highlight the significant patient delay experienced by patients in western China and the complex pathways to care that confront TB patients in rural areas. Additionally, this is one of the first meta-analyses of median outcomes in this area that also considers estimations of mean and variation. As such, the pooled results using estimated mean and variation provide a useful indication of the strengths and limitations of this methodological approach. This methodological approach will be useful in identifying areas for research in future.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,016 | 0,036 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,015 | 0,033 |
| Bibliométrie | 0,008 | 0,010 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».