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Free Content Delay in diagnosis of pulmonary tuberculosis at a primary health clinic in Vitoria, Brazil

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SETTING: Primary health clinics in Vitoria, Espirito Santo, Brazil.

OBJECTIVE: To identify risk factors associated with patient and health care delays among patients seeking care at primary health clinics.

METHODS: A prospective study among tuberculosis (TB) patients diagnosed in Vitoria between 1 January 2003 and 30 December 2007. A questionnaire ascertained the date of onset and duration of TB symptoms and medical records were reviewed. Between-group distributions of delay were compared and multivariate logistic regression was performed.

RESULTS: Of 304 patients, 296 (97%) reported at least one TB symptom presenting for the first time to a qualified health service; 244 (80%) reported cough > 3 weeks. Median health care delay was 30 days (range 5–68), and median total delay was 110 days (range 26–784). Multivariate analysis revealed any cough (ORadj 7.35, 95%CI 2.40–22.5) and weight at TB diagnosis < 60 kg (ORadj 5.92, 95%CI 1.83–19.1) to be associated with patient delay of ≥30 days. Factors increasing risk of prolonged delay (≥90 days) were age ≥30 years (ORadj 1.93, 95%CI 1.09–3.43) and chest pain (ORadj 2.42, 95%CI 1.29–4.53).

CONCLUSION: Improving health care workers' education regarding TB symptoms and implementing active case finding in targeted populations may reduce delays.

Keywords: delayed diagnosis; epidemiology; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Nucleo de Doenças Infecciosas, Universidade Federal do Espirito Santo, Vitoria, Espirito Santo, Brazil 2: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 3: Yale University School of Medicine, New Haven, Connecticut, USA 4: Tuberculosis Control Program, Tuberculosis Control Program for the Vitoria City Secretary of Health, Vitoria, Espirito Santo, Brazil 5: Tuberculosis Control Program, Hospital Universitario Cassiano Antonio Moraes, Vitoria, Espirito Santo, Brazil

Publication date: November 1, 2010

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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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