DELAY OF DIAGNOSIS AND TREATMENT OF NEW SMEAR POSITIVE PULMONARY TB IN RURAL AREA; GAZIERA STATE, SUDANMohammed A. S.*, Bjune G. **, and El Sony A. I. ****EpiLab, Khartoum, Sudan, MPhil International Community Health, University of Oslo, Norway; **Department of General Practice and Community Health, Faculty of Medicine, University of Oslo, Norway; *** EpiLab, Khartoum, Sudan.
Background: The basics of TB control are based on early detection and treatment of infectious cases. Early detection is controlled by both patient’s and health system’s factors. In this study we explored some of both patient’s and health system’s factors that contributed to longer period of infectiousness of TB. Objectives: The overall goal of this study was to determine the magnitude of both total delay and total period of TB diagnosis and initiation of anti TB treatment and to investigate the possible contributing factors. Setting: All levels of health services within Gaziera State, Sudan. 77% of population was rural settled during the last 3 centuries after a past history of nomadic life. The population is multi ethnic and multi cultural. Design: A quantitative cross sectional study during the period 17th of July 2005 to 11th of January 2006. Results: Two hundred and sixteen new smear positive pulmonary TB patients were recruited. The mean total diagnostic period was 69.66±28.14 days. 87.5% delayed for more than 42 days. Risk factors for long mean total diagnostic period were being divorced or widow, family monthly income more than 100 US$, other health providers visited before TBMU and having to pay for services in public health facilities. The mean patient’s period was 36.6±23.13 days. 61.6% was delayed for more than 1 month. Risk factors for long mean patient’s period were being 25-54 years old, being alone in a room in the house, distance more than 30 minutes walk to TBMU and sputum for AFB grade scanty or 1+. The mean total health system’s period was 33.05±24.5 days. 79.2% were delayed for more than 2 weeks. The mean other health provider’s period was 29.1±24.7 days. 78.7% were delayed for more than 9 days. The risk factors for long means total health system’s and other health provider’s period were being of female gender, divorced or widow, students or without income generating activity, family monthly income more than 100 US$, distance between 15 to 30 minutes walk to TBMU, blood investigation performed, more than one other health provider consulted and having to pay full fees or being covered by health insurance to the public health facility. The mean TBMU’s period was 3.99±1.6 days. 14.8% were delayed for more than 5 days. Risk factors for long mean TBMU’s period were being 25-54 years old, living alone in a room in the house, distance between 15 to 30 minutes walk to TBMU and sputum for AFB grade 2 ++. The mean post referral period was 4.32±6.87 days. Risk factors for long post referral mean period were being older than 25 years, divorced or widow, higher level of education, rural residence, free access to public health facility and sputum for AFB grade 2 ++. Conclusion: Delay of TB diagnosis and treatment was highly prevalent in this area. Both patients and health system share an equal responsibility. Patient’s factors can modulate health system’s period while health system factors play the same role for patient’s period. For patients, socio demographic factors played a crucial role in modulating the diagnostic period. For the health system, other health provider’s practice toward TB suspect played a role. Economical factors were found to contribute to both periods i.e. health system and patient. More researches to explore socio demographic bases influencing patient’s period should be conducted while coordination between TBMUs and other health providers should be the focus of TB control in the future. Poverty reduction policies would be a crucial factor as a contributor to shorten total diagnostic period. Evaluation of new TB diagnostic tools should put in consideration the overlapping of patient’s and health system’s periods, like post referral period.