title: Delay in the diagnosis, notification and initiation of treatment and compliance in children with tuberculosis.
abstract: METHODS
  The mortality and morbidity from childhood tuberculosis may be influenced by the delay from the time of first symptoms until the start of and compliance with treatment.
  
  
  OBJECTIVE
  This study investigated these delay periods and the compliance with therapy in children with tuberculosis.
  
  
  METHODS
  During the study period there were 49 children with probable and 123 with confirmed pulmonary tuberculosis (WHO criteria). The mean period from first symptoms until presentation was 4.3 weeks, from presentation until notification 5 weeks and from notification until therapy 0.9 weeks. 16% of children notified as having tuberculosis never received therapy. Significantly fewer children in the urban squatter communities received therapy than in urban settled (P = 0.02), rural agricultural (P = 0.0001) and rural settled (P = 0.09) communities. 12% of children did not complete their therapy.
  
  
  CONCLUSIONS
  The delay in presentation ('patient delay') was shorter than the delay in diagnosis ('doctor delay'). Failure to trace children and to complete therapy was particularly likely to occur in urban squatter communities. Easier access to health care facilities may shorten the 'patient delay' while greater awareness of tuberculosis and proper investigation of children may shorten the 'doctor delay'.
authors.affiliation: Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg Hospital, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Beyers
authors.forename: R P
authors.initials: RP
authors.lastname: Gie
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
authors.forename: S
authors.initials: S
authors.lastname: van Zyl
authors.forename: E D
authors.initials: ED
authors.lastname: Nel
authors.forename: J M
authors.initials: JM
authors.lastname: Talent
authors.forename: P R
authors.initials: PR
authors.lastname: Donald
mesh_terms: D002648:Child; D002675:Child, Preschool; D018563:Disease Notification; D006801:Humans; D007223:Infant; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D012423:Rural Health; D013019:South Africa; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D014504:Urban Health