Delay in the diagnosis of tuberculosis (TB) causes more severe illness, more complication and an increased period of infectivity in the community. A study in Amhara region in 2001 showed that, among those who had history of cough of more than 3 weeks, only 30% visited the formal health care facilities. We hypothesized that there was a significant patients and health systems delay in the diagnosis of pulmonary TB in Amhara region, and this study was conducted to test our hypothesis.
Objectives: To determine and analyze the length and associated risk factors of patients health providers and health systems delay among new smear positive pulmonary TB patients in Amhara region, Northwest Ethiopia.
Methods: Within the setting of government health care facilities in Amhara region, we conducted a cross-sectional study from September 1 - December 31/2003. A total of 384 new smear positive pulmonary TB patients participated in the study. Patients were interviewed on the same date of the diagnosis using a semi-structured questionnaire.
Result: The median total delay was 80 days (IQR 44-130 days) and the median patients delay was 30 days (IQR 15-90 days). Forty eight percent of the subjects delayed for more than one month. The median health providers and health systems delays were 61 and 21 days, respectively. In logistics regression, home distance >10 Km to a medical provider (adjusted odds ratio [ORadj] 3.81, 95% confidence interval [CI] 2.21-6.57) and self-treatment (adjusted odds ratio [ORadj] 1.69, 95% confidence interval [CI] 1.86-6.57) were associated with patients delay. Prior attendance to a health post/clinic (adjusted odds ratio [ORadj] 3.50, 95% confidence interval [CI] 1.86-6.57) and consulting private medical providers (adjusted odds ratio [ORadj] 2.10, 95% confidence interval [CI] 1.18-3.71) were associated with increased health systems delay.
Conclusion: Delay in the diagnosis of pulmonary TB is unacceptably high in Amhara region. The delay is primarily related to the health providers. Accessing a simple and rapid diagnostic test for TB at the lowest health care facilities (health post/clinic) andencouraging a dialogue among all health providers are imperative interventions to reduce health systems delays. Besides these, due emphasis should be given to further decentralization of DOTS to the periphery and increasing public awareness of the disease among the population.