title: Traditional healers, treatment delay, performance status and death from TB in rural South Africa.
abstract: BACKGROUND
  People in sub-Saharan Africa frequently consult traditional healers before reaching the government health services (GHS). This can lead to delays in starting effective anti-tuberculosis chemotherapy. To our knowledge, no studies have shown a direct relationship between visiting traditional healers, increased morbidity and death from TB.
  
  
  METHODS
  All patients starting on anti-tuberculosis chemotherapy at a rural hospital in South Africa in 2003 were included in the study. TB nurses interviewed the patients and established how long they had had symptoms before treatment was started, whether they had visited traditional healers before coming to the hospital, their performance status and, later, whether they had died.
  
  
  RESULTS
  Of 133 patients, those who attended a traditional healer took longer to access anti-tuberculosis chemotherapy (median 90 days, range 0-210) than those who went directly to the GHS (median 21, range 0-120). Patients who visited a traditional healer had worse performance status (P < 0.001), and were more likely to die (24/77 [31%] vs. 4/33 [12%], P = 0.04).
  
  
  CONCLUSIONS
  Treatment delay due to visiting traditional healers can have dire consequences for patients with TB. Efforts are required to engage with health care practitioners outside the government sector to improve the prospects for patients with TB.
authors.affiliation: Department of Respiratory Medicine, King's College Hospital, London, UK. jack.barker@kingsch.nhs.uk
authors.forename: R D
authors.initials: RD
authors.lastname: Barker
authors.forename: F J C
authors.initials: FJ
authors.lastname: Millard
authors.forename: J
authors.initials: J
authors.lastname: Malatsi
authors.forename: L
authors.initials: L
authors.lastname: Mkoana
authors.forename: T
authors.initials: T
authors.lastname: Ngoatwana
authors.forename: S
authors.initials: S
authors.lastname: Agarawal
authors.forename: S
authors.initials: S
authors.lastname: de Valliere
mesh_terms: D006801:Humans; D008519:Medicine, Traditional; D012423:Rural Health; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000401:mortality* / Q000628:therapy*