title: Health care-seeking behaviour and diagnostic delays for Human African Trypanosomiasis in the Democratic Republic of the Congo.
abstract: OBJECTIVE
  About half of the patients with Human African trypanosomiasis (HAT) reported in the Democratic Republic of the Congo (DRC) are currently detected by fixed health facilities and not by mobile teams. Given the recent policy to integrate HAT control into general health services, we studied health seeking behaviour in these spontaneously presenting patients.
  
  
  METHODS
  We took a random sample from all patients diagnosed with a first-time HAT episode through passive case finding between 1 October 2008 and 30 September 2009 in the two most endemic provinces of the DRC. Patients were approached at their homes for a structured interview. We documented patient delay (i.e. time between onset of symptoms and contacting a health centre) and health system delay (i.e. time between first contact and correct diagnosis of HAT).
  
  
  RESULTS
  Median patient delay was 4 months (IQR 1-10 months, n = 66); median health system delay was 3 months (IQR 0.5-11 months). Those first presenting to public health centres had a median systems delay of 7 months (IQR 2-14 months, n = 23). On median, patients were diagnosed upon the forth visit to a health facility (IQR 3rd-7th visit).
  
  
  CONCLUSIONS
  Substantial patient as well as health system delays are incurred in HAT cases detected passively. Public health centres are performing poorly in the diagnostic work-up for HAT, mainly because HAT is a relatively rare disease with few and non-specific early symptoms. Integration of HAT diagnosis and treatment into general health services requires strong technical support and well-organized supervision and referral mechanisms.
authors: Epidemiology and Disease Control Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. ehasker@itg.be
authors: E
authors: E
authors: Hasker
authors: C
authors: C
authors: Lumbala
authors: F
authors: F
authors: Mbo
authors: A
authors: A
authors: Mpanya
authors: V
authors: V
authors: Kande
authors: P
authors: P
authors: Lutumba
authors: M
authors: M
authors: Boelaert
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011634:Public Health; D011795:Surveys and Questionnaires; D013997:Time Factors; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014353:Trypanosomiasis, African / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D014344:Trypanocidal Agents