Abstract
BackgroundEarly detection and treatment of tuberculosis cases are the hallmark of successful tuberculosis control. We conducted a cross-sectional study at public primary health facilities in Kampala city, Uganda to quantify diagnostic delay among pulmonary tuberculosis (PTB) patients, assess associated factors, and describe trajectories of patients' health care seeking.Methodology/Principal FindingsSemi-structured interviews with new smear-positive PTB patients (≥15 years) registered for treatment. Between April 2007 and April 2008, 253 patients were studied. The median total delay was 8 weeks (IQR 4–12), median patient delay was 4 weeks (inter-quartile range [IQR] 1–8) and median health service delay was 4 weeks (IQR 2–8). Long total delay (>14 weeks) was observed for 61/253 (24.1%) of patients, long health service delay (>6 weeks) for 71/242 (29.3%) and long patient delay (>8 weeks) for 47/242 (19.4%). Patients who knew that TB was curable were less likely to have long total delay (adjusted Odds Ratio [aOR] 0.28; 95%CI 0.11–0.73) and long patient delay (aOR 0.36; 95%CI 0.13–0.97). Being female (aOR 1.98; 95%CI 1.06–3.71), staying for more than 5 years at current residence (aOR 2.24 95%CI 1.18–4.27) and having been tested for HIV before (aOR 3.72; 95%CI 1.42–9.75) was associated with long health service delay. Health service delay contributed 50% of the total delay. Ninety-one percent (231) of patients had visited one or more health care providers before they were diagnosed, for an average (median) of 4 visits (range 1–30). All but four patients had systemic symptoms by the time the diagnosis of TB was made.Conclusions/SignificanceDiagnostic delay among tuberculosis patients in Kampala is common and long. This reflects patients waiting too long before seeking care and health services waiting until systemic symptoms are present before examining sputum smears; this results in missed opportunities for diagnosis.
Highlights
Despite improvements in many aspects of tuberculosis control, delayed diagnosis of tuberculosis still remains a big challenge in many countries
Detection and effective treatment of cases are the hallmark of any successful tuberculosis control programme [2]
We studied diagnostic delay among smear-positive pulmonary tuberculosis (PTB) patients registered for treatment at primary care clinics in Kampala city, Uganda
Summary
Despite improvements in many aspects of tuberculosis control, delayed diagnosis of tuberculosis still remains a big challenge in many countries. Detection and effective treatment of cases are the hallmark of any successful tuberculosis control programme [2]. Identification and cure of infectious TB cases is recommended as the most cost-effective control measure [3]. Delayed diagnosis results in more extensive disease [4], complications and increased mortality [5]. Delayed diagnosis and treatment lead to prolonged infectiousness [6]. The costs arising from the delay in diagnosing TB are substantial and may worsen the economic situation of patients and their families [7]. Detection and treatment of tuberculosis cases are the hallmark of successful tuberculosis control. We conducted a cross-sectional study at public primary health facilities in Kampala city, Uganda to quantify diagnostic delay among pulmonary tuberculosis (PTB) patients, assess associated factors, and describe trajectories of patients’ health care seeking
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