Factors associated with patient and health care system delay in diagnosis for tuberculosis in the province of Luanda, Angola

Abstract

BackgroundTuberculosis (TB) is still a great challenge to public health in sub-Saharan Africa. Most transmissions occur between the onset of coughing and initiation of treatment. Delay in diagnosis is significant to disease prognosis, thus early diagnosis and prompt effective therapy represent the key elements in controlling the disease. The objective of this study was to investigate the factors influencing the patient delay and the health system delay in TB diagnosis in Angola.MethodsOn a cross-sectional study, 385 TB patients who visited 21 DOTS clinics in Luanda were included consecutively. The time from the onset of symptoms to the first consultation of health providers (patients’ delay) and the time from the first consultation to the date of diagnosis (health system’s delay) were analysed. Bivariate and logistics regression were applied to analyse the risk factors of delays.ResultsThe median total time elapsed from the onset of symptoms to diagnosis was 45 days (interquartile range [IQR]: 21–97 days). The median patient delay was 30 days (IQR: 14–60 days), and the median health care system delay was 7 days (IQR: 5–15 days). Primary education (AOR = 1.75; CI [95%] 1.06–2.88; p <0.029) and the health centre of the first contact differing from the DOTS centre (AOR = 1.66; CI [95%] 1.01–2.75; p <0.046) were independent risk factors for patient delay >4 weeks. Living in a suburban area (AOR = 2,32; CI [95%] 1.21–4.46; p = 0.011), having a waiting time in the centre >1 hour (AOR = 4.37; CI [95%] 1.72–11.14; p = 0.002) and the health centre of the first contact differening from the DOTS centre (AOR = 5.68; CI [95%] 2.72–11,83; p < 0,00001) were factors influencing the system delay.ConclusionsThe results indicate that the delay is principally due to the time elapsed between the onset of symptoms and the first consultation. More efforts should be placed in ensuring the availability of essential resources and skills in all healthcare facilities other than the DOTS centres, especially those located in suburban areas.

Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study

“…The studies in Addis Ababa and Southern Region of Ethiopia were conducted in urban setting where better diagnostic facilities and experienced health care providers are available. The median health system’s delay in our study is also higher than findings of similar studies done in other African countries such as Angola [23] and Zimbabwe [24]. …”

Patient and Doctor Delays in Smear-Negative and Smear-Positive Pulmonary Tuberculosis Patients Attending a Referral Hospital in Istanbul, Turkey

“…Although tuberculosis is both preventable and curable, it remains a leading infectious cause of morbidity and mortality worldwide [5, 9]. The primary goal of tuberculosis control programs is to minimize transmission within the community and reduce tuberculosis incidence by detecting and treating active tuberculosis disease as early as possible [3–5].…”

“…We evaluated patient delay, doctor delay, referral delay, clinical delay, and total delay in our study. While intervals that exceeded 30 days were considered indicative of a patient delay in the majority of previous studies [2, 7, 9], there are no universally accepted criteria for doctor delay and its subgroups [3, 6]. For smear-positive patient group, we used delay criteria described by authors in a previous study from Turkey [2].…”

“…For smear-positive patient group, we used delay criteria described by authors in a previous study from Turkey [2]. While we used the same criteria for patient delay and referral delay in smear-negative patient group, we measured clinical delay, doctor delay, and total delay by using different cut-off points [2, 9]. …”

“…The total interval was the time between the onset of symptoms and time of treatment initiation. While intervals that exceeded 45 days were considered indicative of a total delay in group 1, a period of more than 34 days was indicative of a total delay in group 2 [2, 9]. The reasons for the delays were also evaluated.…”