Factors affecting time delay to treatment in a tuberculosis control programme in a sub-Saharan African country: the experience of The Gambia
Abstract:SETTING: Rural and urban health centres in The Gambia, West Africa.
OBJECTIVES: To estimate the time delay between onset of symptoms and initiation of treatment and identify the risk factors influencing the delay in patients with tuberculosis (TB).
DESIGN: Structured interviews with newly diagnosed TB patients aged over 15 years presenting to TB control staff in four health centres.
RESULTS: A total of 152 TB patients were interviewed. The median delay from onset of symptoms to commencement of treatment was 8.6 weeks (range 5–17). Delay to treatment was independent of sex, but was shorter in young TB patients. The median delay was longer in rural than in urban areas (12 weeks [range 8.5–17] vs. 8 [4–12], P < 0.01) and in those who did not attend school, but this effect disappeared after adjusting for age and area of residence. Patients who reported haemoptysis as one of their initial symptoms had shorter delays to treatment. There was no relation between duration of delay to treatment and cure rate, but longer delay did increase the risk of death.
CONCLUSION: Starting TB patients on treatment as early as possible plays a major role in reducing disease transmission in the community. Key to this is increasing awareness of the signs and symptoms of TB and ensuring easy access to diagnostic facilities and treatment.
Document Type: Regular Paper
Affiliations: 1: Medical Research Council Laboratories, Fajara, Banjul, The Gambia; London School of Hygiene & Tropical Medicine, London, UK 2: Medical Research Council Laboratories, Fajara, Banjul, The Gambia 3: National Tuberculosis and Leprosy Control Programme, Ministry of Health, Banjul, The Gambia 4: Internal Medicine Residency Program, University of Toronto, Toronto, Canada
Publication date: March 1, 2001
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