Free Content Delay and discontinuity—a survey of TB patients' search of a diagnosis in a diversified health care system

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SETTING: Ho Chi Minh City (HCMC), Vietnam.

OBJECTIVES: To describe delay to diagnosis; to compare diagnostic procedures and referral routines used by private and public health care providers; and to examine associations between contact with various types of providers and risk of delay to TB diagnosis.

DESIGN: Cross-sectional survey of new patients in the National Tuberculosis Programme (NTP). Retrospective assessment of health seeking and diagnostic procedures used by previously contacted health care providers.

RESULTS: Four weeks after first symptom, 81% of patients had sought help outside the household. Four weeks after first health care contact, 47% had been diagnosed with TB. Private physicians used X-rays, sputum smears, and referrals significantly less often than public health care providers. Patients who had turned first to a private pharmacy, a private physician or a public hospital were significantly more likely to have a long provider delay than those who turned first to the NTP.

CONCLUSION: Delay to diagnosis of TB in HCMC is due more to inability among health care providers to detect TB than to under-utilisation of health care services. Diagnostic procedures need to be improved and referral chains need to be strengthened in HCMC, particularly among private providers.

Keywords: Vietnam; diagnostic delay; private health care; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Social Medicine, Göteborg University, Göteborg, Sweden; and Nordic School of Public Health, Göteborg, Sweden 2: Pham Ngoc Thach TB and Lung Disease Center, Ho Chi Minh City, Vietnam 3: Nordic School of Public Health, Göteborg, Sweden; and Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

Publication date: November 1, 1999

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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