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AlHamawi R, Khader Y, Abaza H, Satyanarayana S, Wilson N, Saleh Abu Rumman A, Okkah K. Tuberculosis-related knowledge, practices, perceived stigma and discrimination among patients with tuberculosis: a cross-sectional study in Jordan. Infect Dis (Lond) 2024; 56:359-375. [PMID: 38329456 DOI: 10.1080/23744235.2024.2311292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Tuberculosis knowledge, practices, and perceived stigma and discrimination among patients with tuberculosis are key factors for the management of the disease. OBJECTIVES The objectives of the study were to assess knowledge, practices, perceived stigma and discrimination, perceived family and health workers support, perceived level of satisfaction with healthcare services, delay in diagnosis/treatment and reasons for delay among patients with tuberculosis in Jordan. METHODS A cross-sectional study was conducted among patients who were under treatment for tuberculosis in Jordan in 2021. RESULTS This study included a total of 452 patients with tuberculosis. About 91.4% of patients had low to moderate overall tuberculosis-related knowledge score and 8.6% had high knowledge score. Almost two-thirds of patients (67.5%) had perceived a low level of stigma, 61 (13.5%) perceived a moderate level of stigma, and 86 (19.0%) perceived a high level of stigma. The majority (84.5%) of patients with tuberculosis thought that there was a delay in diagnosis and/or treatment of tuberculosis. CONCLUSION Our study showed gaps in tuberculosis knowledge and practices, high perceived stigma and discrimination, and perceived delay in diagnosis and treatment initiation,. Efforts within the national tuberculosis control program should be made to increase public awareness about the symptoms of tuberculosis and the importance of seeking early care.
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Affiliation(s)
- Rana AlHamawi
- Research and policy Global Health Development|Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Yousef Khader
- Professor of Epidemiology, Medical Education and Biostatistics, Department of Community Medicine, Public Health, and Family Medicine/, Jordan University of Science & Technology, Irbid, Jordan
| | - Hiba Abaza
- Migration Health Division, International Organization for Migration (IOM) Amman, Jordan
| | - Srinath Satyanarayana
- Migration Health Division, International Organization for Migration (IOM) Amman, Jordan
| | - Nevin Wilson
- Migration Health Division, International Organization for Migration (IOM) Amman, Jordan
| | | | - Khaled Okkah
- Department of Chest Disease and Foreigners, Jordan Ministry of health, Jordan
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Fetensa G, Wirtu D, Etana B, Wakuma B, Tolossa T, Gugsa J, Gobena D, Fekadu G, Ragasa MT, Ejeta E. Tuberculosis treatment delay and contributing factors within tuberculosis patients in Ethiopia: A systematic review and meta-analysis. Heliyon 2024; 10:e28699. [PMID: 38586418 PMCID: PMC10998239 DOI: 10.1016/j.heliyon.2024.e28699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
Background Tuberculosis (TB) is a significant public health disease and a major contributor to illness and death worldwide, including in Ethiopia. There are many information from first source which had inconclusive result in Ethiopia. Therefore, this review aimed to produce pooled evidence on the TB treatment delay and factors associated with it. Methods The absence of a similar study with a systematic review and meta-analysis was confirmed. Articles from online available and unpublished sources conducted within Ethiopia between 2002 and 2024, were thoroughly screened using electronic sources such as Medline, Embase, Hinari, PubMed, the Cochrane Library, the Web of Science, and Google Scholar. Data analysis was performed using STATA version 14. Heterogeneity was assessed using Inverse of Variance (I2) and Cochrane Q tests. The funnel plot was employed to rule existence of publications subjectively while bias was checked using Egger's statistical method to quantify the bias. Result Prevalence of TB treatment delay in Ethiopia was 50.42% at 95% (43.21, 57.64). Factors such as knowledge about TB, distance to health facilities less than 10 km, initial contact at a government service providing center for TB, having some educations, having pulmonary Tuberculosis, urban residency, were prtotective towards treatment delay. Female in gender, no chest pain symptom, disease severity with no restriction on daily activity, alcohol drinkers, and unmarried respondents were at higher risk to miss on time tuberculosis treatment. Conclusion and recommendation The tuberculosis treatment delay in Ethiopia was considerably unexpected and basic personal variables and facility related variables were statistically associated with treatment. Therefore, Ethiopian TB control programs have to recognize and tackle the problem, obstacles, and vulnerability across the continuum patient care taking down and connecting to treatment post-diagnosis. This can be achieved by capacitating both government and non-governmental service provision centers and minimizing unfilled difference across professional awareness and skill, which will contribute further to minimizing delay.
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Affiliation(s)
- Getahun Fetensa
- Department of Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- Department of Health, Behavior, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Dessalegn Wirtu
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Belachew Etana
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- Department of Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Jilcha Gugsa
- Oromia Physician Association, Addis Ababa, Ethiopia
- Batu General Hospital, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Dabesa Gobena
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
- School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Misganu Teshoma Ragasa
- Department of Midwifery, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Eshetu Ejeta
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- Department of Public Health, Ambo University, Ambo, Ethiopia
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Zhang Y, Zhan B, Hao X, Wang W, Zhang X, Fang C, Wang M. Factors associated with diagnostic delay of pulmonary tuberculosis among children and adolescents in Quzhou, China: results from the surveillance data 2011-2021. BMC Infect Dis 2023; 23:541. [PMID: 37596514 PMCID: PMC10439644 DOI: 10.1186/s12879-023-08516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE Tuberculosis is a high-burden disease and a major health concern in China, especially among children and adolescents. The purpose of this study was to assess risk factors for diagnostic delay in students with pulmonary tuberculosis in Quzhou City in eastern China. PATIENTS AND METHODS Cases of PTB in students and relevant information in Quzhou from 2011 to 2021 were collected using the TB Management Information System. The outcome of interest was diagnostic delay (i.e. ≥ 28 days between symptom onset and treatment initiation). Risk factors for diagnostic delay were identified using multivariable logistic regression. RESULTS A total of 629 students in Quzhou were diagnosed with PTB during the study period, of whom 55.5% were male. The median diagnostic delay was 18 days (Inter Quartile Range, [IQR]: 8-38) and 38.0% of the students had a diagnostic delay. Living in a rural area (adjusted odds ratio, [AOR]: 1.56, 95% confidence interval [CI:] 1.11-2.19), developing PTB symptoms in the first quarter of the year (AOR: 2.18, 95% CI: 1.40-3.40), and no sputum smear result (AOR: 8.73, 95% CI: 1.68-45.30) were significantly associated with a diagnostic delay. Discovery through health examinations (AOR: 0.33, 95% CI: 0.17-0.63) was associated with reduced risk of diagnostic delay. CONCLUSION Schools in rural areas should pay special attention to increasing student awareness of the symptoms of tuberculosis and provide health education on tuberculosis prevention and control to students and staff.
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Affiliation(s)
- Yating Zhang
- School of Public Health, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Bingdong Zhan
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Xiaogang Hao
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Wei Wang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Xing Zhang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Chunfu Fang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Min Wang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China.
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Chaiya C, Panezai S, Saqib SE, Ashraf M. Satisfaction of Tuberculosis Patients with Directly Observed Treatment Strategy under Pakistan Health Care Policy: A Mixed-Method Study. Healthcare (Basel) 2022; 10:healthcare10122529. [PMID: 36554053 PMCID: PMC9778783 DOI: 10.3390/healthcare10122529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Patients' satisfaction is based on the perceived health care services of individuals and is influenced by the level of care provided by the health care system. It is often based on the patients' expectations of care and self-assessment of their experiences. The success of the Directly Observed Treatment Strategy (DOTS) also depends on the quality of health care provided at the Tuberculosis (TB) centers, which can be evaluated by satisfaction levels of the patients. (2) Methods: A tuberculosis facility-based cross-sectional study was carried out in Khyber Pakhtunkhwa province in Pakistan. A mixed-method approach was adopted for data collection. An interviewer-administered questionnaire was used for quantitative data collection from 269 patients who were registered at 11 TB centers and private clinics. Qualitative data were collected through 20 in-depth interviews, 15 key informant interviews, and a focus-group discussion. Binary logistic regression was employed for analysis of the data. (3) Results: More than half of the respondents (63.94%) were satisfied with the DOTS strategy. A high percentage of patients were dissatisfied with the availability of safe water, waiting space for patients, waiting time, privacy, and the processing of appointments. Results from the binary logistic regression showed that gender (AOR = 2.21, CI 1.07-4.58, p = 0.033), marital status (AOR = 3.12, CI 1.45-6.73, p = 0.004), employment status (AOR = 5.22, CI 2.44-1.21, p = 0.000), home ownership (AOR = 3.82, CI 1.94-7.54, p = 0.000), literacy (AOR = 2.17, CI 1.11-4.25, p = 0.023), households' main occupation (AOR = 4.42, CI 1.12-17.38, p = 0.033), and level of income (AOR = 2.39, CI 1.13-5.04, p = 0.023) were the significant factors affecting satisfaction levels of the patients. (4) Conclusion: There are a number of areas that need improvement for successful TB eradication. Significant work is required to improve the quality of TB care in these specific areas from the patients' perspective. For instance, female health workers' involvement in the DOTS program can solve the problems of female respondents in rural areas. Improving the infrastructure facilities at the TB centers, allocation of doctors and nurses at the rural health centers would result in positive outcomes of the DOTS in Pakistan as well as in other developing countries.
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Affiliation(s)
- Chitralada Chaiya
- College of Politics and Governance, Mahasarakham University, Maha Sarakham 44150, Thailand
- Correspondence: ; Tel.: +66-831-879-358
| | - Sanaullah Panezai
- Department of Geography and Regional Planning, University of Balochistan, Quetta 87300, Pakistan
| | - Shahab E. Saqib
- Directorate of Commerce Education and Management Sciences, Higher Education Department Khyber Pakhtunkhwa, Peshawar 25000, Pakistan
| | - Muhammad Ashraf
- Department of Disaster Management and Development Studies, University of Balochistan, Quetta 87300, Pakistan
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AlHamawi R, Khader Y, Abaza H, Satyanarayana S, Wilson N, Abu Rumman AS, Okkah K. Tuberculosis-related knowledge, practices, perceived stigma and discrimination, and adherence to anti-TB medication among patients with tuberculosis: A cross-sectional study in Jordan (Preprint). JMIR Public Health Surveill 2022. [DOI: 10.2196/43766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Fetensa G, Wirtu D, Etana B, Tolossa T, Wakuma B. Magnitude and determinants of delay in diagnosis of tuberculosis patients in Ethiopia: a systematic review and meta-analysis: 2020. Arch Public Health 2022; 80:78. [PMID: 35287725 PMCID: PMC8919582 DOI: 10.1186/s13690-022-00837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Tuberculosis (TB) remains a main public health concern in the world resulting in significant morbidity and mortality as well as in Ethiopia. In Ethiopia, there are various primary studies with inconsistent findings. Delay in the diagnosis of TB is determined by different factors like the type of TB, marital status, TB-HIV co-infection, employment status, place of residence, educational status, type of first visited a health facility, and gender of the patient. This review will produce pooled evidence on delay in diagnosis and associated factors among TB that might have huge public health impacts, like unfavorable treatment outcomes, increase transmission of the disease in the community for better intervention. Methods The presence of systematic reviews and meta-analysis on similar topics was checked and the topic was registered on PROSPERO to prevent duplication with the registration number of (CRD42020158963). Both published and unpublished studies conducted in Ethiopia from 2002 to April 1 2020 were searched thoroughly using electronic databases. Data were analyzed using STATA version 14. Heterogeneity was checked by using I2 and Cochrane Q test. In the presence of heterogeneity, a random effect model was employed to estimate the pooled magnitude and determinants of diagnosis delay of TB. Publication bias was checked by using the graphical funnel plot and Egger’s statistical test. Result The Pooled magnitude of tuberculosis diagnosis delay in Ethiopia was 45.42% [95%CI 34.44, 56.40]. Residing in urban, having educational status and patients with positive serostatus were protective against TB diagnostic delay while having extra-pulmonary TB and not being married were risk factors for delaying TB diagnosis. Conclusion TB diagnosis delays in Ethiopia are significantly high. Sociodemographic and institutional factors were significantly contributing to the delay. Therefore, national TB control programs need to identify and address gaps, barriers, and weaknesses along the entire patient care cascade, to improve appropriately.
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Affiliation(s)
- Getahun Fetensa
- Department of Nursing, School of Nursing and Midwifery, Institute of Health Sciences Wollega University, Nekemte, Ethiopia. .,Department of Health, Behavior and Society, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Desalegn Wirtu
- Department of Public Health, Institute of Health sciences, Wollega University, Nekemte, Ethiopia
| | - Belachew Etana
- Department of Public Health, Institute of Health sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- Department of Nursing, School of Nursing and Midwifery, Institute of Health Sciences Wollega University, Nekemte, Ethiopia
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Khan FU, Khan FU, Hayat K, Chang J, Kamran M, Khan A, Malik UR, Khan A, Fang Y. Impact of Protracted Displacement on Delay in the Diagnosis Associated with Treatment Outcomes: A Cross-Sectional Study in Internally Displaced Tuberculosis Patients of Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211984. [PMID: 34831746 PMCID: PMC8621790 DOI: 10.3390/ijerph182211984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/06/2021] [Accepted: 11/11/2021] [Indexed: 12/03/2022]
Abstract
Human displacement is on the rise globally, and the increase in the burden of tuberculosis (TB) is also attributed to migrations worldwide. A significant number of such displacements occur in regions with considerably higher areas of TB burden. Displacements may delay TB diagnosis and treatment, which will possibly lead to TB transmission among healthy individuals. In this study, we assessed the association of existing determinants after a protracted internal displacement of people with delay in TB diagnosis and treatment outcomes. A cross-sectional study was conducted on internally displaced TB patients (IDPs), registered at selected health facilities in three urban districts of Pakistan from March 2019 to February 2020. The univariate and multivariate logistic regression model was used to assess the delay in diagnosis and treatment outcomes. IDPs with delay in initiation of treatment beyond 30 days were at high possibility of unsuccessful TB treatment outcomes (adjusted odds ratio AOR, 2.60; 95% CI 1.06–6.40). Furthermore, the multivariate regression analysis showed a statistically significant association (p > 0.05) between TB patients who were aged 55 to 65 years (AOR, 2.66; 95% CI 1.00–7.07), female patients (AOR, 2.42; 95% CI 1.21–4.81), visited non-formal health provider (AOR, 8.81; 95% CI 3.99–19.46), self-medication (AOR, 2.72; 95 % CI 1.37–5.37), poor knowledge of TB (AOR, 11.39; 95% CI 3.31–39.1), and perceived stigma (AOR, 8.81; 95% CI 3.99–19.4). Prolonged delay in treatment was associated with unfavorable treatment outcomes among IDPs. Migrants and IDPs are more likely to experience an interruption in care due to overall exclusion from social and health care services. Therefore, it is imperative to understand the barriers to providing public health care services, particularly in preventing and treating TB.
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Affiliation(s)
- Farman Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
| | - Muhammad Kamran
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan; (M.K.); (A.K.)
| | - Asad Khan
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan; (M.K.); (A.K.)
| | - Usman Rashid Malik
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
| | - Asif Khan
- District Bannu TB Control Program Unit, Headquarter Hospital Bannu, Bannu 28100, Pakistan;
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
- Correspondence:
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Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res 2021; 22:251. [PMID: 34556113 PMCID: PMC8459488 DOI: 10.1186/s12931-021-01841-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thirty countries with the highest tuberculosis (TB) burden bear 87% of the world's TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the duration and determinants of delayed diagnosis and treatment of pulmonary TB in high TB-burden countries. METHODS We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. We performed a narrative synthesis of the covariates significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. RESULTS This review included 124 articles from 14 low- and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC). The pooled median duration of delays (in days) were-patient delay (LIC/LMIC: 28 (95% CI 20-30); UMIC: 10 (95% CI 10-20), health system delay (LIC/LMIC: 14 (95% CI 2-28); UMIC: 4 (95% CI 2-4), and treatment delay (LIC/LMIC: 14 (95% CI 3-84); UMIC: 0 (95% CI 0-1). There was consistent evidence that being female and rural residence was associated with longer patient delay. Patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Organizational and policy factors mediated health system and treatment delays. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high-burden countries. CONCLUSIONS This review presented the duration of delays and detailed the determinants of delayed TB diagnosis and treatment in high-burden countries. The gaps identified could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care. PROSPERO registration: CRD42018107237.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, USA
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Arja A, Godana W, Hassen H, Bogale B. Patient delay and associated factors among tuberculosis patients in Gamo zone public health facilities, Southern Ethiopia: An institution-based cross-sectional study. PLoS One 2021; 16:e0255327. [PMID: 34329333 PMCID: PMC8323940 DOI: 10.1371/journal.pone.0255327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 07/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background Delayed tuberculosis diagnosis and treatment increase morbidity, mortality, expenditure, and transmission in the community. Early diagnosis and initiation of treatment are essential for effective TB control. Therefore, the main objective of this study was to assess the magnitude and factors associated with patient delay among tuberculosis patients in Gamo Zone, Southern Ethiopia. Methods A cross-sectional study was conducted in Gamo Zone, Southern Ethiopia from February to April 2019. Fifteen health facilities of the study area were selected randomly and 255 TB patients who were ≥18 years of age were included. Data were collected using a questionnaire through face-to-face interviews and analyzed using SPSS version 20.0. Patient delay was analyzed using the median as the cut-off value. Multivariable logistic regression analysis was fitted to identify factors associated with patient delay. A p-value of ≤ 0.05 with 95% CI was considered to declare a statistically significant association. Results The median (inter-quartile range) of the patient delay was 30 (15–60) days. About 56.9% of patients had prolonged patients’ delay. Patient whose first contact were informal provider (adjusted odds ratio [AOR]: 2.24; 95% confidence interval [CI] 1.29, 3.86), presenting with weight loss (AOR: 2.53; 95%CI: 1.35, 4.74) and fatigue (AOR: 2.38; 95%CI: 1.36, 4.17) and body mass index (BMI) categories of underweight (AOR: 1.74; 95%CI: 1.01, 3.00) were independently associated with increased odds of patient delay. However, having good knowledge about TB (AOR: 0.44; 95% CI: 0.26, 0.76) significantly reduce patients’ delay. Conclusion In this study, a significant proportion of patients experienced more than the acceptable level for the patient delay. Knowledge about TB, the first action to illness, presenting symptoms, and BMI status were identified factors associated with patient delay. Hence, raising public awareness, regular training, and re-training of private and public healthcare providers, involving informal providers, and maintenance of a high index of suspicion for tuberculosis in the vulnerable population could reduce long delays in the management of TB.
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Affiliation(s)
- Asrat Arja
- Bursa District Health Office, Bursa, Sidama Region, Ethiopia
- * E-mail:
| | - Wanzahun Godana
- Schools of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Hadiya Hassen
- Schools of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Biruk Bogale
- Departments of Public Health, Mizan Tepi University, Mizan Aman, Ethiopia
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10
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Tuberculosis related stigma. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.854373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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Zhou TJ, Lakshminarayanan S, Sarkar S, Knudsen S, Horsburgh CR, Muthaiah M, Kan CK, Salgame P, Ellner JJ, Roy G, Jenkins HE, Hochberg NS. Predictors of Loss to Follow-Up among Men with Tuberculosis in Puducherry and Tamil Nadu, India. Am J Trop Med Hyg 2020; 103:1050-1056. [PMID: 32618243 PMCID: PMC7470548 DOI: 10.4269/ajtmh.19-0415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Identifying predictors of loss to follow-up (LTFU; treatment lapse ≥ 2 months) among people with tuberculosis (TB) may assist programmatic efforts in controlling the spread of TB. Newly diagnosed smear-positive TB patients were enrolled in the Regional Prospective Observational Research for TB study in Puducherry and Tamil Nadu, India. Treatment records were used to identify LTFU of those who were enrolled from May 2014 through December 2017. This nested case–control study evaluated male TB patients. Predictors were assessed using multivariable logistic regression. Of 425 men with TB, 82 (19%) were LTFU. In the adjusted analyses of males, divorced/separated marital status (adjusted odds ratio [aOR] 3.80; 95% CI: 1.39–10.38) and at-risk alcohol use (aOR 1.92; 95% CI: 1.12–3.27) were significant predictors for increased risk of LTFU, and diabetes was a significant predictor for decreased risk of LTFU (aOR 0.52; 95% CI: 0.29–0.92). Of 53 men with recorded date of last treatment visit, 23 (43%) and 43 (81%) had LTFU within the first 2 and first 4 months of treatment, respectively. Addressing at-risk alcohol use and providing more intensive follow-up could lead to improved treatment completion.
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Affiliation(s)
- Thomas J Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Subitha Lakshminarayanan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Selby Knudsen
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.,Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Muthuraj Muthaiah
- Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Puducherry, India
| | - Carolyn K Kan
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Padmini Salgame
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jerrold J Ellner
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Helen E Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Natasha S Hochberg
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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12
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Delay for Tuberculosis Treatment and Its Predictors among Adult Tuberculosis Patients at Debremarkos Town Public Health Facilities, North West Ethiopia. Tuberc Res Treat 2020; 2020:1901890. [PMID: 33014464 PMCID: PMC7520669 DOI: 10.1155/2020/1901890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/30/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022] Open
Abstract
Background Delay in the diagnosis and treatment of tuberculosis exacerbates the disease and clinical outcomes. It further enhances transmission of the infection in the society as well as increased the severity of the illness and raised rate of mortality. Objectives The major goal of this study is to determine the magnitude of delays in tuberculosis treatment and factors affecting tuberculosis treatment among adult tuberculosis patients at Debremarkos town, North West Ethiopia, 2018. Methods Institution-based cross-sectional study design was employed. Systematically selected 300 adult TB patients were recruited to the study. The study was conducted at Debremarkos town public health facilities from March 1 to April 30, 2018. Logistic regression models were fitted to identify the predicting variables and control confounder's of the outcome variables. P value ≤ 0.05 with 95% CI was considered as an indicator for the presence of statistically significant association. The result revealed that the median total delay was 23 days (IQR: 19-28 days). The median patient and health system delays were 20 days (IQR: 15-20 days) and 4 days (IQR: 3-5 days), respectively. Tuberculosis patients living in a rural area were 1.14 times more likely to delay for the TB treatment (AOR: 1.141, 95% CI (1.106, 2.608)). Patients who were unable to read and write have almost two times a chance of being delayed (AOR: 2.350, 95% CI (1.630, 2.608)). Monthly income of patients has found another predictor for delay; patients with low monthly income were about six times more likely to delay for TB treatment (AOR: 6.375, 95% CI: (1.733, 23.440)). Those TB patients who had visiting traditional healers before arrival to health facilities were about 2.7 times more likely to delay for TB treatment(AOR: 2.795, 95% CI (1.898, 8.693)). Conclusion and Recommendation. The significant proportion of delays in tuberculosis treatment was found in this study. Living in the rural area, unable to read and write, lower monthly income, and visiting traditional healers were found independent predictors of TB treatment delay. The regional and zonal health administrator shall design various awareness creation mechanisms to educate the public about timely initiation of tuberculosis treatment.
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13
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Der JB, Grint D, Narh CT, Bonsu F, Grant AD. Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana. PLoS One 2020; 15:e0230604. [PMID: 32191768 PMCID: PMC7081980 DOI: 10.1371/journal.pone.0230604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Ghana’s national prevalence survey showed higher than expected tuberculosis (TB) prevalence, indicating that many people with TB are not identified and treated. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment. Methods A prospective cohort study was conducted in urban and rural health facilities in south-east Ghana. Consecutive patients routinely identified as needing a TB test were followed up for two months to find out if sputum was submitted and/or treatment started. The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression. Results A total of 428 persons (mean age 48 years, 67.3% female) were recruited, 285 (66.6%) from urban and 143 (33.4%) from rural facilities. Of 410 (96%) individuals followed up, 290 (70.7%) submitted sputum, among which 27 (14.1%) had a positive result and started treatment. Among those who visited an urban facility, 245/267(91.8%) submitted sputum, compared to 45/143 (31.5%) who visited a rural facility. Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84–42.51). After adjustment for confounding, there was still a strong association between attending the urban facility and submitting sputum (adjusted OR (aOR) 9.52, 95%CI 3.87–23.40). Travel distance of >10 km to the laboratory was the strongest predictor of not submitting sputum (aOR 0.12, 95%CI 0.05–0.33). Conclusion The majority of presumptive TB patients attending a rural health facility did not submit sputum for testing, mainly due to the long travel distance to the laboratory. Bridging this gap in the diagnostic cascade may improve case detection.
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Affiliation(s)
- Joyce B. Der
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- * E-mail:
| | - Daniel Grint
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clement T. Narh
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg – University Mainz, Mainz, Germany
| | - Frank Bonsu
- Department of Disease Control and Prevention, National TB Control Program, Ghana Health Service, Accra, Ghana
| | - Alison D. Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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14
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Cazabon D, Pande T, Sen P, Daftary A, Arsenault C, Bhatnagar H, O'Brien K, Pai M. User experience and patient satisfaction with tuberculosis care in low- and middle-income countries: A systematic review. J Clin Tuberc Other Mycobact Dis 2020; 19:100154. [PMID: 32140571 PMCID: PMC7044748 DOI: 10.1016/j.jctube.2020.100154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Patient-centered care is at the forefront of the End TB strategy, yet little is known about user (patient's) experience and patient satisfaction with TB services. Our study aims to systematically review quantitative studies evaluating user experience and TB patient satisfaction within the health care system. Methods Five medical databases were systematically searched between January 1st, 2009 and December 31st, 2018. English studies assessing user experience and patient satisfaction within the healthcare system from a TB patient's perspective in low and middle-income countries, were included. Results Thirty-five studies from 16 low and middle-income countries evaluated three major themes; facilities and patient centeredness (n = 23), patient-provider relationship (n = 22) and overall satisfaction (n = 19). Overall study quality was low as they used varying tools to measure user experience and patient satisfaction. Conclusion Our study shows large variability in measurement of user experiences and patient satisfaction. Studies reported that patients were mostly satisfied with TB care services, and those that were dissatisfied were substantially more likely to be lost to follow-up. The high satisfaction rates could have been due to lack of education on good quality patient care or fear of losing access to health care. A standardized patient centered tool could be designed to help assess user experience and patient satisfaction to allow comparisons among health systems and countries.
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Affiliation(s)
| | - Tripti Pande
- McGill International TB Center, Montreal, Canada
| | - Paulami Sen
- McGill International TB Center, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Amrita Daftary
- School of Health Policy and Management, York University, Toronto, Canada
| | | | | | - Kate O'Brien
- We are TB/National TB Controllers Association, Smryna, USA
| | - Madhukar Pai
- McGill International TB Center, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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15
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Saqib SE, Ahmad MM, Panezai S. Care and social support from family and community in patients with pulmonary tuberculosis in Pakistan. Fam Med Community Health 2019; 7:e000121. [PMID: 32148725 PMCID: PMC6910765 DOI: 10.1136/fmch-2019-000121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives This study aimed to validate the Medical Outcome Study-Social Support Survey (MOS-SSS) instrument in Pakistan and to quantify the nature of care and social support currently extended to patients with pulmonary tuberculosis (TB) in Pakistan. Design This is a cross-sectional study design conducted within a period of 3 months from 1 November 2016 to 31 January 2017. Participants A total of 269 patients, registered at 11 TB centres and private clinics, were interviewed through an interviewer-administered questionnaire. Main outcome measures Cronbach's alpha was used to measure the internal consistency and reliability of the MOS-SSS survey instrument. Univariate and multivariable logistic regressions have been used to explore the association between care and social support, and socioeconomic factors. Result This study validated the use of the MOS-SSS among patients with TB in Pakistan. Findings of the study revealed significant differences among the socioeconomic groups of patients in each subscale of social support. Additionally, results of logistic regressions showed that patients who were older (adjusted OR=6.17, 95% CI 1.55 to 24.59, p≤0.01), male (adjusted OR=2.73, 95% CI 1.49 to 4.98, p≤0.01), widow (adjusted OR=0.17, 95% CI 0.04 to 0.80, p≤0.05), and had a larger household size (adjusted OR=5.69, 95% CI 1.32 to 24.65, p≤0.05), higher monthly income (adjusted OR=2.00, 95% CI 1.11 to 3.60, p≤0.05) and house ownership (adjusted OR=1.99, 95% CI 1.10 to 3.60, p≤0.05) were significant factors associated with the extent of care and social support that the participants received. Conclusion To cure TB, this study suggests a coordinated approach that includes not only clinical services to address this issue but also a strong social support system based on family and community necessary throughout the treatment process.
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Affiliation(s)
- Shahab E Saqib
- Department of Regional and Rural Development Planning, Asian Institute of Technology, Bangkok, Thailand
| | - Mokbul Morshed Ahmad
- Department of Regional and Rural Development Planning, Asian Institute of Technology, Bangkok, Thailand
| | - Sanaullah Panezai
- Department of Geography, University of Balochistan, Quetta, Balochistan, Pakistan
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