Delay in diagnosis of pulmonary tuberculosis at a primary health clinic in Vitoria, Brazil
Abstract: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.
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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