title: Factors affecting time delay to treatment in a tuberculosis control programme in a sub-Saharan African country: the experience of The Gambia.
abstract: METHODS
  Rural and urban health centres in The Gambia, West Africa.
  
  
  OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical Research Council Laboratories, Fajara, Banjul, The Gambia. lienhardt@dakar.ird.sn
authors.forename: C
authors.initials: C
authors.lastname: Lienhardt
authors.forename: J
authors.initials: J
authors.lastname: Rowley
authors.forename: K
authors.initials: K
authors.lastname: Manneh
authors.forename: G
authors.initials: G
authors.lastname: Lahai
authors.forename: D
authors.initials: D
authors.lastname: Needham
authors.forename: P
authors.initials: P
authors.lastname: Milligan
authors.forename: K P
authors.initials: KP
authors.lastname: McAdam
mesh_terms: D000293:Adolescent; D000328:Adult; D003140:Communicable Disease Control; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D012424:Rural Population; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D014505:Urban Population