title: Health care seeking behaviour for tuberculosis symptoms in Kiev City, Ukraine.
abstract: METHODS
  Tuberculosis (TB) doctors in Kiev City have the impression that TB patients often present with advanced TB disease, and the mortality rate among TB patients is high. Delay in seeking health care may explain these observations.
  
  
  OBJECTIVE
  To assess the magnitude of patient delay and evaluate risk factors for delay.
  
  
  METHODS
  We included 190 newly diagnosed pulmonary TB patients. For each patient, information was gathered through interviews and from the medical records.
  
  
  RESULTS
  The median time between the start of symptoms and the first visit to a health care provider (patient delay) was 30.0 days. Individuals reporting unemployment, cough or loss of weight before seeking health care had a longer patient delay. The same applies to individuals with the risk factors homelessness, joblessness or alcohol abuse. The main reasons for delay among those who presented late were 'thought symptoms would go away' and 'symptoms not considered serious'.
  
  
  CONCLUSIONS
  For most TB patients, the time between start of symptoms and first health care seeking action was acceptable. Long patient delay was reported by individuals who were homeless, jobless or abused alcohol. Specific activities will have most effect if they are targeted at these vulnerable and difficult to reach groups.
authors.affiliation: KNCV Tuberculosis Foundation, The Hague, The Netherlands. vanderwerfm@kncvtbc.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: van der Werf
authors.forename: Y
authors.initials: Y
authors.lastname: Chechulin
authors.forename: O B
authors.initials: OB
authors.lastname: Yegorova
authors.forename: T
authors.initials: T
authors.lastname: Marcinuk
authors.forename: A
authors.initials: A
authors.lastname: Stopolyanskiy
authors.forename: V
authors.initials: V
authors.lastname: Voloschuk
authors.forename: M
authors.initials: M
authors.lastname: Zlobinec
authors.forename: A
authors.initials: A
authors.lastname: Vassall
authors.forename: J
authors.initials: J
authors.lastname: Veen
authors.forename: E
authors.initials: E
authors.lastname: Hasker
authors.forename: L V
authors.initials: LV
authors.lastname: Turchenko
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology* / Q000628:therapy; D014455:Ukraine / Q000453:epidemiology; D014505:Urban Population