Factors associated with delay in seeking treatment for acute bleeding among Haemophiliacs at Haemophilia treatment centres in Uganda

Abstract

Introduction: Haemophilia is associated with a high tendency of acute bleeding episodes which can lead to severe morbidity and mortality in the absence of prompt care. Patients often delay seeking care leading to adverse outcomes. Information on factors associated with delays is limited. Objective: This study set out to determine the extent and factors associated with delays in seeking treatment for acute bleeding among haemophiliacs receiving treatment at five treatment centres. This is aimed at enhancing good health-seeking behaviours for better health outcomes. Methods: The study was conducted in five haemophilia treatment centres across Uganda and used a cross-sectional design with mixed methods of data collection. A total of 224 haemophilia cases with acute bleeding episodes seeking care at the treatment centres were consecutively sampled. A pre-tested questionnaire was used to collect information and a qualitative approach was used to explore health workers’ perceptions on factors associated with delays in seeking treatment among patients. The health workers were purposively selected and data were collected using Key Informant Interviews. The quantitative data were analyzed using STATA version 16 while qualitative data were manually analyzed using the inductive thematic analysis to generate codes, categories, sub-themes and themes. Multivariate modified Poisson regression analysis was used to determine factors associated with delay to seeking treatment at HTC. Results: Time taken following an acute bleeding symptom to the HTC ranged between 1 and 65 hours with a median of 9 hours. Patients were more likely to delay seeking treatment at HTCs for acute bleeding episodes if they used public means of transport to the HTC (aPR 1.39; 95% CI 1.22-1.59). Patients who took immediate other actions on recognition of a sign of an acute bleeding episode were less likely to delay seeking treatment at the HTC (aPR 0.75; 95% CI 0.66-0.84). Conclusion: There was substantially a long period of delay (9 hours) to seek treatment among patients seeking treatment at the HTCs compared to the recommended time of 2 hours for an acute bleed. There is a need for tailored interventions and modification of strategies by haemophilia patient support organisations with special attention to patients who live in rural areas and those with crippling physical disabilities and implementation of guidelines by MOH to support practice for healthworkers.