Prevalence and Factors Associated with Delayed Treatment of Pulmonary Tuberculosis Among Stateless People in Chiang Rai, Thailand

Abstract

Delayed tuberculosis (TB) treatment is a significant public health challenge in Thailand and a key factor contributing to the continued transmission of TB. This study aimed to examine the prevalence and associated factors of delayed treatment among pulmonary TB patients who are stateless people in Chiang Rai Province. A quantitative, cross-sectional study design was employed. Purposive sampling was used to select 166 pulmonary TB patients who are stateless and registered for treatment in Ministry of Public Health hospitals in Chiang Rai between October 1, 2022, and March 31, 2024. Data were collected using a questionnaire with Cronbach’s alpha coefficient of 0.89. Descriptive statistics were used to analyze general data, and multiple logistic regression analysis was applied to identify significant factors associated with treatment delay, with a 95% confidence interval (CI). The results showed that 57.83% of the participants were male, with an average age of 55 years. A total of 64.76% had no formal education. The prevalence of treatment delay beyond 30 days was 63.25%, with an average duration of 93 days from the onset of showing symptoms to treatment initiation. Multivariate analysis revealed two statistically significant factors associated with delayed treatment (p < .05): low levels of TB-related attitudes (adjusted odds ratio [ORadj] = 3.71, 95% CI = 1.41–9.78) and not seeking care at the nearest health center (ORadj = 5.13, 95% CI = 1.84–14.31). Based on these findings, proactive interventions should be implemented for stateless people and non-Thai nationals from neighboring countries. Recommended strategies include community-based active case finding, TB education and awareness programs, and the development of local health collaboration networks to facilitate timely treatment, reduce TB prevalence, and effectively prevent transmission in border areas.