Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: a cross-sectional studyReport as inadecuate

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BMC Public Health

, 5:122

First Online: 24 November 2005Received: 10 February 2005Accepted: 24 November 2005DOI: 10.1186-1471-2458-5-122

Cite this article as: Kiwuwa, M.S., Charles, K. & Harriet, M.K. BMC Public Health 2005 5: 122. doi:10.1186-1471-2458-5-122


BackgroundDelays in diagnosis and initiation of effective treatment increase morbidity and mortality from tuberculosis as well as the risk of transmission in the community. The aim of this study was to determine the time taken for patients later confirmed as having TB to present with symptoms to the first health provider patient delay and the time taken between the first health care visit and initiation of tuberculosis treatment health service delay. Factors relating to these -delays- were analyzed.

MethodsA cross-sectional survey, of 231 newly diagnosed smear-positive tuberculosis patients was conducted in Mulago National referral Hospital Kampala, from January to May 2002. Socio-demographic, lifestyle and health seeking factors were evaluated for their association with patient delay >2 weeks and health service delay >4 weeks, using odds ratios with 95% confidence intervals CI including multivariate logistic regression.

ResultsThe median total delay to treatment initiation was 12 weeks. Patients often presented to drug shops or pharmacies 39.4% and private clinics 36.8% more commonly than government health units 14% as initial contacts. Several independent predictors of -patient delay- were identified: being hospitalized odds ratio 0R = 0.32; 95% CI: 0.12–0.80, daily alcohol consumption OR = 3.7; CI: 1.57–9.76, subsistence farming OR = 4.70; CI: 1.67–13.22, and perception of smoking as a cause of TB OR = 5.54; CI: 2.26–13.58. Independent predictors of -health service delay- were: >2 health seeking encounters per month OR = 2.74; CI: 1.10–6.83, and medical expenditure on TB related symptoms >29 US dollars OR = 3.88; CI: 1.19–12.62. Perceived TB stigma and education status was not associated with either form of delay.

ConclusionDelay in diagnosis of TB is prolonged at the referral centre with a significant proportion of Health service delay. More specific and effective health education of the general public on tuberculosis and seeking of appropriate medical consultation is likely to improve case detection. Certain specific groups require further attention. Alcoholics and subsistence farmers should be targeted to improve accessibility to TB treatment. Continuing medical education about TB management procedures for health providers and improvement in the capacity of TB control services should be undertaken.

Keywordspulmonary tuberculosis health-seeking behavior treatment delay Karamagi Charles and Mayanja Kizza Harriet contributed equally to this work.

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Author: Mpungu S Kiwuwa - Karamagi Charles - Mayanja Kizza Harriet


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