OR for 6-week mortality by health system delays among paediatric and adult participants in the severe febrile illness social biopsy study, Tanzania, 2015–2016
| Health system delay | Paediatric (n=160)* | Adult (n=81)† | ||||||||
| Cases (n=18)‡ | Controls (n=142)‡ | OR (95% CI) | P value | AF§ (95% CI) | Cases (n=34)‡ | Controls (n=47)‡ | OR (95% CI) | P value | AF§ (95% CI) | |
| Patient did not get referred to a hospital from the first facility after onset of severe symptom | 12 (66.7) | 94 (68.6) | 0.85 (0.29 to 2.47) | 0.770 | – | 24 (70.6) | 31 (67.4) | 1.13 (0.43 to 2.92) | 0.808 | – |
| Patient did not take themselves to a hospital after onset of severe symptom (i.e. did not ‘short-circuit’ referral) | 8 (47.1) | 43 (36.1) | 1.64 (0.60 to 4.44) | 0.335 | – | 11 (32.4) | 11 (28.2) | 1.07 (0.30 to 3.78) | 0.915 | – |
| Patient did not receive antibiotics at the first peripheral facility after onset of severe symptom | 1 (5.6) | 13 (9.3) | 0.62 (0.08 to 4.94) | 0.648 | – | 6 (17.6) | 4 (8.7) | 2.15 (0.59 to 7.75) | 0.243 | – |
| Patient reported a barrier at a health facility due to discrimination, language or physical access¶ | 7 (38.9) | 27 (19.0) | 2.63 (0.92 to 7.54) | 0.073 | – | 6 (17.6) | 11 (23.4) | 0.80 (0.26 to 2.51) | 0.703 | – |
| Patient waited >1 hour to receive medication at any point** | 6 (33.3) | 43 (30.7) | 1.02 (0.36 to 2.89) | 0.966 | – | 9 (26.5) | 15 (31.9) | 0.76 (0.29 to 2.00) | 0.573 | – |
| Patient visited >2 facilities | 7 (38.9) | 26 (18.3) | 2.57 (0.92 to 7.22) | 0.073 | – | 16 (47.1) | 10 (21.3) | 3.73 (1.19 to 11.69) | 0.024 | 34.5 (18.4 to 47.4) |
| Patient waited >1 hour to be seen by a provider at any point** | 5 (27.8) | 47 (33.3) | 0.75 (0.26 to 2.17) | 0.600 | – | 8 (23.5) | 13 (27.7) | 0.66 (0.22 to 2.02) | 0.468 | – |
| Patient reported delay due to cost of health care | 3 (16.7) | 11 (7.7) | 2.26 (0.62 to 8.30) | 0.218 | – | 3 (8.8) | 4 (8.5) | 0.91 (0.20 to 4.12) | 0.898 | – |
| Patient did not complete a given treatment due to patient or caregiver decision | 6 (33.3) | 46 (32.4) | 1.05 (0.38 to 2.90) | 0.926 | – | 13 (38.2) | 12 (25.5) | 2.20 (0.73 to 6.64) | 0.163 | – |
| Patient spent >4 days in the health care system | 10 (55.6) | 32 (22.5) | 4.39 (1.49 to 12.93) | 0.007 | 42.9 (27.4 to 55.1) | 16 (47.1) | 10 (21.3) | 3.15 (1.11 to 8.92) | 0.030 | 32.1 (14.7 to 46.0) |
| Total number of facilities visited | 2.5 (1.4)† | 1.9 (0.9)† | 1.59 (1.06 to 2.38) | 0.024 | – | 2.8 (1.7)† | 1.9 (0.9)† | 2.00 (1.17 to 3.41) | 0.011 | – |
| Time spent in the health care system (days) | 8.8 (12.0)† | 3.4 (4.5)† | 1.09 (1.02 to 1.17) | 0.009 | – | 10.0 (14.9)† | 4.5 (7.5)† | 1.06 (1.00 to 1.13) | 0.054 | – |
| Total number of dichotomous health system delays present | 3.7 (1.7)† | 2.8 (1.7)† | 1.27 (0.99 to 1.64) | 0.064 | – | 3.3 (2.2)† | 2.6 (2.0)† | 1.02 (0.94 to 1.53) | 0.153 | – |
| Total number of dichotomous home, transport and health system delays present | 5.2 (2.4)† | 3.9 (2.2)† | 1.28 (1.03 to 1.59) | 0.027 | – | 4.9 (2.7)† | 3.9 (2.6)† | 1.16 (0.96 to 1.40) | 0.133 | – |
*Paediatric analysis is based on 9:1 nearest-neighbour matching with deduplication based on age and gender.
†Adult analysis is based on 2:1 nearest-neighbour matching with deduplication based on age, gender and severity of illness.
‡Data are reported as n (%) unless otherwise noted.
§Attributable fraction is reported as a percentage and is only given for the dichotomous delays significantly associated with mortality on conditional logistic regression analysis.
¶This was a composite delay created due to anticipated low prevalence of three separate delays. A participant had this composite delay if the patient experienced at least one of the following during at least one facility encounter: discrimination, a language barrier or a physical access barrier.
**We also estimated the OR for this delay at the first facility, the last facility and the first or last facility, none of which were significant.
††Data reported as mean (SD).
AF, attributable fraction.