Abstract
IntroductionDelay in the diagnosis of pulmonary tuberculosis (PTB) is common in many countries in Sub-Saharan Africa. Timely diagnosis of active tuberculosis is crucial in minimizing morbidity and mortality in the community as well as nosocomial transmission in health care facilities. This study aimed at determining factors associated with health service delay in the diagnosis and initiation of treatment among new PTB patients presenting to the National Referral Hospital-Mulago.MethodsThis was a cross-sectional study among eligible new PTB patients presenting at the National referral TB treatment center Mulago hospital, between March to May 2009. The patients were consecutively recruited and interviewed using a semi-structured questionnaire to assess socio- demographic and health service factors. Multivariate logistic regression using odds ratios and 95% confidence intervals was done.ResultsTwo hundred and sixty six newly diagnosed PTB patients were enrolled, of which 65.4% experienced health systems delay. The median health service delay was 9days (IQR=8-19). Factors associated with health service delay were: 1n-patient (OR= 4.68, 95% CI: 1.91-11.45), secondary as highest level of education attained (OR= 3.56, 95% CI: 1.18-10.74), primary as highest level of education attained (OR= 6.70, 95% CI: 2.13-21.02), presence of fever (OR= 3.28, 95% CI: 1.05-10.79), and patient delay at health facility (OR= 5.01, 95% CI: 1.33-18.9).ConclusionThe study found a significant proportion of Health service delay among pulmonary tuberculosis patients presenting at the referral hospital. Being an in-patient and having fever as a symptom of tuberculosis needs further attention in order to have timely diagnosis. There is need for awareness on TB especially that most of the TB symptoms present like other febrile illnesses such as malaria and needs consideration when patients present to a health facility.
Highlights
Delay in the diagnosis of pulmonary tuberculosis (PTB) is common in many countries in Sub-Saharan Africa
Between March and May 2009, a cross-sectional study to assess factors associated with health service delay in the diagnosis and initiation of TB treatment was done among patients with PTB attending the National Tuberculosis Referral Center (NTRC), Kampala city, Uganda
The study found a significant proportion of Health service delay among pulmonary tuberculosis patients presenting at the referral hospital
Summary
Delay in the diagnosis of pulmonary tuberculosis (PTB) is common in many countries in Sub-Saharan Africa. This study aimed at determining factors associated with health service delay in the diagnosis and initiation of treatment among new PTB patients presenting to the National Referral Hospital-Mulago. The burden of TB is escalating, but a significant problem lies with the fact that many cases remain undiagnosed This could be due to a number of factors, principally found within the categories: patients delay and health service delay. Delay in the diagnosis may worsen the disease in terms of morbidity and mortality in the communities as well as the health care facilities, enhance tuberculosis transmission in the community and patientsawareness to tuberculosis symptoms together with health workersability to diagnose the disease are important factors to control the spread of the infection in a community [4]
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