title: Health service delay among pulmonary tuberculosis patients presenting to a National Referral Hospital, Kampala, Uganda: a cross sectional study.
abstract: BACKGROUND
  Delay in the diagnosis of pulmonary tuberculosis (PTB) is common in many countries in Sub-Saharan Africa. Timely diagnosis of active tuberculosis is crucial in minimizing morbidity and mortality in the community as well as nosocomial transmission in health care facilities. This study aimed at determining factors associated with health service delay in the diagnosis and initiation of treatment among new PTB patients presenting to the National Referral Hospital-Mulago.
  
  
  METHODS
  This was a cross-sectional study among eligible new PTB patients presenting at the National referral TB treatment center Mulago hospital, between March to May 2009. The patients were consecutively recruited and interviewed using a semi-structured questionnaire to assess socio- demographic and health service factors. Multivariate logistic regression using odds ratios and 95% confidence intervals was done.
  
  
  RESULTS
  Two hundred and sixty six newly diagnosed PTB patients were enrolled, of which 65.4% experienced health systems delay. The median health service delay was 9days (IQR=8-19). Factors associated with health service delay were: 1n-patient (OR= 4.68, 95% CI: 1.91-11.45), secondary as highest level of education attained (OR= 3.56, 95% CI: 1.18-10.74), primary as highest level of education attained (OR= 6.70, 95% CI: 2.13-21.02), presence of fever (OR= 3.28, 95% CI: 1.05-10.79), and patient delay at health facility (OR= 5.01, 95% CI: 1.33-18.9).
  
  
  CONCLUSIONS
  The study found a significant proportion of Health service delay among pulmonary tuberculosis patients presenting at the referral hospital. Being an in-patient and having fever as a symptom of tuberculosis needs further attention in order to have timely diagnosis. There is need for awareness on TB especially that most of the TB symptoms present like other febrile illnesses such as malaria and needs consideration when patients present to a health facility.
authors.affiliation: Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P. O Box 7072, Kampala.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kansiime
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Kiwuwa
authors.forename: Mugenyi
authors.initials: M
authors.lastname: Levi
authors.forename: Benon B
authors.initials: BB
authors.lastname: Asiimwe
authors.forename: Achilles
authors.initials: A
authors.lastname: Katamba
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D004522:Educational Status; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D008297:Male; D012017:Referral and Consultation; D013183:Sputum / Q000382:microbiology; D061665:Time-to-Treatment; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy*; D014454:Uganda / Q000453:epidemiology
keywords: Tuberculosis; diagnostic delay; health service delay; pulmonary tuberculosis; treatment delay