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Open Access Highly Accessed Research article

Delays in diagnosis and treatment of pulmonary tuberculosis in Wakiso and Mukono districts, Uganda

Esther Buregyeya13*, Bart Criel2, Fred Nuwaha1 and Robert Colebunders23

Author Affiliations

1 Makerere University School of Public Health, Kampala, Uganda

2 Institute of Tropical Medicine, Antwerp, Belgium

3 University of Antwerp, Antwerp, Belgium

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BMC Public Health 2014, 14:586  doi:10.1186/1471-2458-14-586

Published: 11 June 2014

Abstract

Background

Delay in tuberculosis (TB) diagnosis may worsen the disease and increase TB transmission. Therefore, timely diagnosis and treatment is critical in TB control. We aimed to assess the treatment delay of pulmonary TB and its determinants in two Ugandan districts where TB infection control (TBIC) guidelines were formerly implemented.

Methods

A facility based cross-sectional study was conducted in Mukono and Wakiso districts. Adult pulmonary TB patients within three months of initiating treatment were included in the study. Delays were categorized into unacceptable patient delay (more than 3 weeks from the onset of cough and the first consultation with a health care provider), health service (more than one week from the first consultation to the initiation of TB treatment) and total delay (more than 4 weeks since the onset of cough). The prevalences as well as predictors for the three delays were determined.

Results

We enrolled 158 sputum positive patients. Unacceptable patient delay was noted in 91 (58%) patients, a health service delay in 140 (88%) patients and a total delay in 140 (90%) patients. An independent predictor for patient delay was male gender (pā€‰<ā€‰0.001). First visiting a non-public health facility (pā€‰=ā€‰0.001) was an independent predictor of health service delay.

Conclusion

There is still a significant TB diagnosis and treatment delay in Uganda. Most of the delay was caused by health system delay in the non-public health care sector. There is need for TB advocacy in the community, training of health workers in TBIC and strengthening public-private partnerships in TB control.

Keywords:
TB treatment delay; Patient delay; Health service delay; TB infection control; Uganda