Risk factors for delay in the diagnosis and treatment of tuberculosis at a referral hospital in Rwanda.
METHODS
Kigali University Hospital, the main referral centre for TB in Rwanda.


OBJECTIVE
To evaluate delays in the diagnosis and treatment of tuberculosis (TB) and associated risk factors.


METHODS
Prospective data collection of patients treated for pulmonary TB (PTB) or extra-pulmonary TB (EPTB) between June and September 2006.


RESULTS
Of 104 patients with a mean age of 35 years (range 17-84) recruited into the study, 62% were HIV-positive. EPTB was diagnosed in 60 cases. The median total, health care and patient delays were respectively 57, 28 and 25 days. The health system delay before referral was significantly longer than the delay at our institution (18 vs. 6 days, P<0.0001). Risk factors for a longer health system delay at our institution were smear-negative PTB or EPTB (OR 5.12) and a trial of antibiotics (OR 2.96). The latter was also found to significantly prolong total delay (OR 2.85), as did rural residence (OR 4.86). No significant association was found between patient delay and age, sex, profession or health insurance status.


CONCLUSIONS
Smear-negative PTB and EPTB were associated with longer health system delays. A trial of antibiotics significantly increased the health system delay. Its use, recommended by the World Health Organization in case of smear-negative TB and EPTB in developing countries, needs validation at the tertiary health care level.
Lorent
N
N
Department of Internal Medicine, Belgian Technical Cooperation, Kigali University Hospital, Kigali, Rwanda. natalielorent@yahoo.com
Mugwaneza
P
P
Mugabekazi
J
J
Gasana
M
M
Van Bastelaere
S
S
Clerinx
J
J
Van den Ende
J
J
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology