Skip to main content

Free Content Confusion, caring and tuberculosis diagnostic delay in Cape Town, South Africa

OBJECTIVE: To explore the ways in which provider and patient behaviours interact to exacerbate diagnostic delay in Cape Town, South Africa.

DESIGN: Eight focus group discussions were conducted in four urban communities, all with high tuberculosis (TB) prevalence, including two with high human immunodeficiency virus co-prevalence. Groups were stratified by sex, ethnicity and TB status. Findings were elicited inductively from the dataset using a combination of grounded theory and thematic analysis.

RESULTS: Diagnostic delay was caused by delays in care seeking, provider failure to diagnose TB at first contact, use of the private sector which did not treat TB and multiple care seeking within and between sectors.

CONCLUSION: Patient behaviour interacts with institutional arrangements in a way that materially exacerbates TB diagnostic delay. Care seeking in pluralistic settings needs to be understood as a complex process involving a range of providers across sectors. Strategies to smooth the flow of patients within and between sectors and improve perceptions of both service quality and levels of privacy will reduce diagnostic delays and improve both the efficiency and the effectiveness of the current TB treatment programme.

Keywords: HIV; South Africa; diagnostic delay; health seeking behaviour; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Centre for International Health and Development, University College London Institute for Child Health, London, UK; and London School of Hygiene & Tropical Medicine, London, UK 2: London School of Hygiene & Tropical Medicine, London, UK

Publication date: February 1, 2010

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

  • Editorial Board
  • Information for Authors
  • Subscribe to this Title
  • International Journal of Tuberculosis and Lung Disease
  • Public Health Action
  • Ingenta Connect is not responsible for the content or availability of external websites
  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content