PMID- 21206746
OWN - NLM
STAT- MEDLINE
DCOM- 20110705
LR  - 20240313
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 5
IP  - 12
DP  - 2010 Dec 29
TI  - Long delays and missed opportunities in diagnosing smear-positive pulmonary 
      tuberculosis in Kampala, Uganda: a cross-sectional study.
PG  - e14459
LID - 10.1371/journal.pone.0014459 [doi]
LID - e14459
AB  - BACKGROUND: Early detection and treatment of tuberculosis cases are the hallmark 
      of successful tuberculosis control. We conducted a cross-sectional study at 
      public primary health facilities in Kampala city, Uganda to quantify diagnostic 
      delay among pulmonary tuberculosis (PTB) patients, assess associated factors, and 
      describe trajectories of patients' health care seeking. METHODOLOGY/PRINCIPAL 
      FINDINGS: Semi-structured interviews with new smear-positive PTB patients (>/= 15 
      years) registered for treatment. Between April 2007 and April 2008, 253 patients 
      were studied. The median total delay was 8 weeks (IQR 4-12), median patient delay 
      was 4 weeks (inter-quartile range [IQR] 1-8) and median health service delay was 
      4 weeks (IQR 2-8). Long total delay (>14 weeks) was observed for 61/253 (24.1%) 
      of patients, long health service delay (>6 weeks) for 71/242 (29.3%) and long 
      patient delay (>8 weeks) for 47/242 (19.4%). Patients who knew that TB was 
      curable were less likely to have long total delay (adjusted Odds Ratio [aOR] 
      0.28; 95%CI 0.11-0.73) and long patient delay (aOR 0.36; 95%CI 0.13-0.97). Being 
      female (aOR 1.98; 95%CI 1.06-3.71), staying for more than 5 years at current 
      residence (aOR 2.24 95%CI 1.18-4.27) and having been tested for HIV before (aOR 
      3.72; 95%CI 1.42-9.75) was associated with long health service delay. Health 
      service delay contributed 50% of the total delay. Ninety-one percent (231) of 
      patients had visited one or more health care providers before they were 
      diagnosed, for an average (median) of 4 visits (range 1-30). All but four 
      patients had systemic symptoms by the time the diagnosis of TB was made. 
      CONCLUSIONS/SIGNIFICANCE: Diagnostic delay among tuberculosis patients in Kampala 
      is common and long. This reflects patients waiting too long before seeking care 
      and health services waiting until systemic symptoms are present before examining 
      sputum smears; this results in missed opportunities for diagnosis.
FAU - Sendagire, Ibrahim
AU  - Sendagire I
AD  - Public Health Department, Kampala City Council, Kampala, Uganda.
FAU - Schim Van der Loeff, Maarten
AU  - Schim Van der Loeff M
FAU - Mubiru, Mesach
AU  - Mubiru M
FAU - Konde-Lule, Joseph
AU  - Konde-Lule J
FAU - Cobelens, Frank
AU  - Cobelens F
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20101229
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Attitude to Health
MH  - Communicable Disease Control
MH  - Cross-Sectional Studies
MH  - Early Diagnosis
MH  - Female
MH  - Health Services Accessibility
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Acceptance of Health Care
MH  - Patient Participation
MH  - Surveys and Questionnaires
MH  - Time Factors
MH  - Tuberculosis, Pulmonary/*diagnosis/*epidemiology
MH  - Uganda
PMC - PMC3012078
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2011/01/06 06:00
MHDA- 2011/07/06 06:00
PMCR- 2010/12/29
CRDT- 2011/01/06 06:00
PHST- 2010/07/09 00:00 [received]
PHST- 2010/10/21 00:00 [accepted]
PHST- 2011/01/06 06:00 [entrez]
PHST- 2011/01/06 06:00 [pubmed]
PHST- 2011/07/06 06:00 [medline]
PHST- 2010/12/29 00:00 [pmc-release]
AID - 10-PONE-RA-20963R1 [pii]
AID - 10.1371/journal.pone.0014459 [doi]
PST - epublish
SO  - PLoS One. 2010 Dec 29;5(12):e14459. doi: 10.1371/journal.pone.0014459.