title: Factors associated with patient and health care system delay in diagnosis for tuberculosis in the province of Luanda, Angola.
abstract: BACKGROUND
  Tuberculosis (TB) is still a great challenge to public health in sub-Saharan Africa. Most transmissions occur between the onset of coughing and initiation of treatment. Delay in diagnosis is significant to disease prognosis, thus early diagnosis and prompt effective therapy represent the key elements in controlling the disease. The objective of this study was to investigate the factors influencing the patient delay and the health system delay in TB diagnosis in Angola.
  
  
  METHODS
  On a cross-sectional study, 385 TB patients who visited 21 DOTS clinics in Luanda were included consecutively. The time from the onset of symptoms to the first consultation of health providers (patients' delay) and the time from the first consultation to the date of diagnosis (health system's delay) were analysed. Bivariate and logistics regression were applied to analyse the risk factors of delays.
  
  
  RESULTS
  The median total time elapsed from the onset of symptoms to diagnosis was 45 days (interquartile range [IQR]: 21-97 days). The median patient delay was 30 days (IQR: 14-60 days), and the median health care system delay was 7 days (IQR: 5-15 days). Primary education (AOR = 1.75; CI [95%] 1.06-2.88; p <0.029) and the health centre of the first contact differing from the DOTS centre (AOR = 1.66; CI [95%] 1.01-2.75; p <0.046) were independent risk factors for patient delay >4 weeks. Living in a suburban area (AOR = 2,32; CI [95%] 1.21-4.46; p = 0.011), having a waiting time in the centre >1 hour (AOR = 4.37; CI [95%] 1.72-11.14; p = 0.002) and the health centre of the first contact differening from the DOTS centre (AOR = 5.68; CI [95%] 2.72-11,83; p < 0,00001) were factors influencing the system delay.
  
  
  CONCLUSIONS
  The results indicate that the delay is principally due to the time elapsed between the onset of symptoms and the first consultation. More efforts should be placed in ensuring the availability of essential resources and skills in all healthcare facilities other than the DOTS centres, especially those located in suburban areas.
authors.forename: Luigi
authors.initials: L
authors.lastname: Segagni Lusignani
authors.forename: Gianluca
authors.initials: G
authors.lastname: Quaglio
authors.forename: Andrea
authors.initials: A
authors.lastname: Atzori
authors.forename: Joseph
authors.initials: J
authors.lastname: Nsuka
authors.forename: Ross
authors.initials: R
authors.lastname: Grainger
authors.forename: Maria Da Conceiçao
authors.initials: Mda C
authors.lastname: Palma
authors.forename: Giovanni
authors.initials: G
authors.lastname: Putoto
authors.forename: Fabio
authors.initials: F
authors.lastname: Manenti
mesh_terms: D000328:Adult; D000810:Angola; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003695:Delivery of Health Care / Q000458:organization & administration*; D042241:Early Diagnosis; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*