Delay in the diagnosis and treatment of pulmonary tuberculosis in patients attending a university teaching hospital

SETTING: University Hospital, Kuala Lumpur, Malaysia.

OBJECTIVE: To investigate patient and doctor delays in the diagnosis and treatment of pulmonary tuberculosis in patients attending a tertiary teaching hospital.

DESIGN: A total of 97 patients with newly diagnosed pulmonary tuberculosis at our hospital were interviewed to study the process of case-finding since the onset of symptoms. Time intervals between onset, first medical consultation and the final diagnosis and commencement of antituberculosis treatment were determined. Demographic and clinical features were evaluated for their effect on these intervals.

RESULTS: 36 cases were sputum smear-positive and 61 were smear-negative. Tuberculosis was eventually confirmed in 32 of the smear-negative cases. The medians of patient delay, doctor delay and total delay were 2 weeks, 7 weeks and 12.5 weeks, respectively. The majority of the patients consulted private general practitioners but the diagnosis of tuberculosis was rarely suspected; chest X-ray and sputum examinations were underutilized.

CONCLUSION: To shorten patient delay the public should be educated about the symptoms of tuberculosis and the importance of early medical consultation. Private general practitioners should be more alert to the diagnostic possibility and refer the patients promptly to the government hospitals for appropriate investigation.