Patient and Health Service Delay in the Diagnosis and Treatment of Pulmonary Tuberculosis: The Situation at a Teaching and Referral Hospital in Northwest Ethiopia

Abstract

Background: Delay in the diagnosis and treatment of Pulmonary Tuberculosis (PTB) causes severe disease and higher mortality. It also leads to an increased period of infectivity and transmission in the community. 

Objective: The main aim of this study is to determine patient and health service delay in the diagnosis and treatment of patients with pulmonary tuberculosis. 

Methods: A cross sectional study was conducted at the DOTS Clinic of the University of Gondar Hospital and all adult pulmonary tuberculosis patients who came to the DOTS Clinic for a period of six months were included. Data collection was done through interview of pulmonary tuberculosis patients and review of their medical records.  

Results: Two hundred twenty-two eligible adult TB patients were recruited into the study. Of those who were enrolled, 48.6% were male, 57.2% married, 9.5% unemployed, and 66.2% with no formal education. The mean age was 34 (SD=12), with a median age of 30 years. The mean duration of illness was 5.7 months, with a median and an interquartile range of duration of illness of 4 months and 2-8 months, respectively. The majority of the study participants (72.1%) sought medical advice first at health centers, followed by private clinics (14%), then referral hospitals (7.2%). At the study hospital, the mean duration between consultation with the doctor and start of treatment was 7 days. When asked why they delayed visit of the study hospital, 38.7% of the patients mentioned shortage of money, and 8.1% said distance of health care facilities from home were the reasons. 

Conclusion: Patient delay contributes significantly to delays in patients accessing treatment. Therefore TB control programmes in the catchment area must emphasise patient education regarding symptoms of tuberculosis and timely health seeking behaviour. Continuing medical education about TB management procedures for health providers is also suggested.