Risk factors for treatment delay in pulmonary tuberculosis in Recife, Brazil.
BACKGROUND
Tuberculosis is still a great challenge to public health in Brazil and worldwide. Early detection followed by effective therapy is extremely important in controlling the disease. Recent studies have investigated reasons for delays in treatment, but there is no agreed definition of what constitutes an "acceptable" delay. This study investigates factors associated with total delay in treatment of tuberculosis.


METHODS
A cohort of adult cases of pulmonary tuberculosis diagnosed over a two-year period was studied. Patients were interviewed on entry, reporting the duration of symptoms before the start of treatment, and sputum and blood samples were collected. It was decided that sixty days was an acceptable total delay. Associations were investigated using univariable and multivariable analysis and the population attributable fraction was estimated.


RESULTS
Of 1105 patients, 62% had a delay of longer than 60 days. Age, sex, alcoholism and difficulty of access were not associated with delays, but associations were found in the case of unemployment, having given up smoking, having lost weight and being treated in two of the six health districts. The proportion attributable to: not being an ex-smoker was 31%; unemployment, 18%; weight loss, 12%, and going to the two worst health districts, 25%.


CONCLUSIONS
In this urban area, delays seem to be related to unemployment and general attitudes towards health. Although they reflect the way health services are organized, delays are not associated with access to care.
dos Santos
Martinho A P S
MA
Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Brazil. martinhoapsantos@hotmail.com
Albuquerque
Maria F P M
MF
Ximenes
Ricardo A A
RA
Lucena-Silva
Norma L C L
NL
Braga
Cynthia
C
Campelo
Antônio R L
AR
Dantas
Odimariles M S
OM
Montarroyos
Ulisses R
UR
Souza
Wayner V
WV
Kawasaki
Alexandre M
AM
Rodrigues
Laura C
LC
D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002391:Catchment Area, Health; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000592:standards*; D010342:Patient Acceptance of Health Care; D011635:Public Health Administration / Q000592:standards*; D012959:Socioeconomic Factors; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014478:Unemployment; D014504:Urban Health / Q000706:statistics & numerical data*; D015431:Weight Loss