title: Rural poverty and delayed presentation to tuberculosis services in Ethiopia.
abstract: To measure time to initial presentation and assess factors influencing the decision to seek medical attention, we interviewed 243 patients undergoing sputum examination for the diagnosis of tuberculosis (TB) at a rural health centre near Awassa, Ethiopia. A structured questionnaire was used. Median (mean+SD) patient delay was 4.3 (9.8+12.4) weeks. Delays over 4 weeks were significantly associated with rural residence, transport time over 2 h, overnight travel, transport cost exceeding US $1.40, having sold personal assets prior to the visit, and use of traditional medicine. The majority of patients cited economic or logistical barriers to health care when asked directly about causes of delay. Case-finding strategies for TB must be sensitive to patient delay and health systems must become more accessible in rural areas.
authors.affiliation: St. Elizabeth General Hospital, Shisong, Cameroon. alexiscambanis@yahoo.com
authors.forename: Alexis
authors.initials: A
authors.lastname: Cambanis
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Yassin
authors.forename: Andy
authors.initials: A
authors.lastname: Ramsay
authors.forename: S
authors.initials: S
authors.lastname: Bertel Squire
authors.forename: Isabel
authors.initials: I
authors.lastname: Arbide
authors.forename: Luis E
authors.initials: LE
authors.lastname: Cuevas
mesh_terms: D000293:Adolescent; D000328:Adult; D003906:Developing Countries; D005002:Ethiopia; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011203:Poverty; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000523:psychology*