title: Factors underlying diagnostic delay in tuberculosis patients in a rural area in Tanzania: a qualitative approach.
abstract: BACKGROUND
  Diagnostic delay in patients with tuberculosis (TB) leads to ongoing TB transmission, higher mortality rates and increased patient and government health expenditure. Qualitative research focussed on patients' self-perceptions of disease and their care-seeking behaviour helps to guide health education programmes by providing us with the understanding of the knowledge, attitudes and practices that underlie diagnostic delay.
  
  
  METHODS
  Semi-structured interviews with 28 recently diagnosed TB patients and four traditional healers were conducted. The interviews were audio-recorded and content analysis was performed.
  
  
  RESULTS
  The median total delay was 188 days. The health provider delay (31 days) was longer than the patient delay (21 days) and the health system delay (26 days). The health system delay was longest in patients not being diagnosed at their first hospital visit and subsequently visiting other health care providers, mostly traditional healers.
  
  
  CONCLUSIONS
  A poor knowledge of TB signs and symptoms and patients' beliefs about curses as the origin of diseases lead to delayed care-seeking at the hospital level in an area of North-Western Tanzania. Failure to identify TB cases by formal and non-formal health providers indicates that the education of both communities as well as health workers is essential in order to reduce diagnostic delays.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands. lillyverhagen@hotmail.com
authors.forename: L M
authors.initials: LM
authors.lastname: Verhagen
authors.forename: R
authors.initials: R
authors.lastname: Kapinga
authors.forename: K A W L
authors.initials: KA
authors.lastname: van Rosmalen-Nooijens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D015981:Epidemiologic Factors; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012424:Rural Population / Q000706:statistics & numerical data*; D013636:Tanzania / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult