Determinants of Delay in Diagnosis and Treatment of Pulmonary Tuberculosis in Malawi

Abstract

BACKGROUND: Malawi has operated a National Tuberculosis (TB) control Program since 1984 providing TB services and medications for free to all suspected pulmonary TB patients in the country. However, TB control remains a challenge in the country as revealed by the low case detection rate which is estimated at 65% (2010), which is well below the WHO target of 70%. This indicates a delay in the diagnosis and treatment of the disease among pulmonary TB cases. OBJECTIVES: To determine the extent of, and identify the factors associated with patient and health system delay in the diagnosis and treatment of TB among new and retreatment TB cases in Malawi. METHOD: A hospital based cross-sectional survey of 588 pulmonary TB patients from three TB registration centres, Blantyre, Lilongwe and Mzuzu between July and December 2011. Face to face interviews were employed using a semi-structured questionnaire to collect information related to the delay in diagnosis and treatment of TB among new and retreatment cases. RESULTS: The new TB cases represented 78.2% of the total cases. The median patient delay was 14 days (range 0 – 150) which was the same for both new and retreatment cases. The median health system delay was 56 days (0 - 733), 59 days for new cases and 40.5 days for retreatment cases. Median total delay was 80 days. Primary education, knowing cough lasting > 3 weeks as a TB symptom, and distance were associated with patient delay. The first place of patient visit, and having chest x-ray examination on diagnosis were associated with health system delay. CONCLUSION: The health system delay was significantly longer than patient delay. To reduce the health system delay, the health system needs to be sensitized and the capacity of some non-TB diagnostic facilities need to be enhanced to allow peripheral diagnosis that would ensure prompt referral, diagnosis and treatment of TB. Promote educational interventions in schools and the general public to increase awareness on TB especially on when and where to find TB services.