title: Time to first consultation, diagnosis and treatment of TB among patients attending a referral hospital in Northwest, Ethiopia.
abstract: BACKGROUND
  Early detection and treatment of TB is essential for the success of TB control program performance. The aim of this study was to determine the length and analyze predictors of patients', health systems' and total delays among patients attending a referral hospital in Bahir Dar, Ethiopia.
  
  
  METHODS
  A cross-sectional study was conducted among newly diagnosed TB cases ≥ 15 years of age. Delay was analyzed at three levels: the periods between 1) onset of TB symptoms and first visit to medical provider, i.e. patients' delay, 2) the first visit to a medical provider and the initiation of treatment i.e. health systems' delay and 3) onset of TB symptoms and initiation of treatment i.e. total delay. Uni- and multi-variate logistic regression analyses were performed to investigate predictors of patients', health systems' and total delays.
  
  
  RESULTS
  The median time of patients' delay was 21 days [(interquartile range (IQR) (7 days, 60 days)]. The median health systems' delay was 27 days (IQR 8 days, 60 days) and the median total delay was 60 days (IQR 30 days, 121 days). Patients residing in rural areas had a three-fold increase in patients' delay compared to those from urban areas [Adjusted Odds Ratio (AOR) 3.4; 95% (CI 1.3, 8.9)]. Extra-pulmonary TB (EPTB) cases were more likely to experience delay in seeking treatment compared to pulmonary (PTB) cases [(AOR 2.6; 95% (CI 1.3, 5.4)]. Study subjects who first visited health centres [(AOR) 5.1; 95% (CI 2.1, 12.5)], private facilities [(AOR) 3.5; 95% (CI 1.3, 9.7] and health posts [(AOR) 109; 95% (CI 12, 958], were more likely to experience an increase in health systems' delay compared to those who visited hospitals.
  
  
  CONCLUSIONS
  The majority of TB patients reported to medical providers within an acceptable time after the onset of symptoms. Rural residence was associated with patients' and total delays. Providing the population with information about TB symptoms and the importance of early health seeking may be an efficient way to decrease TB transmission, morbidity and mortality. Establishing efficient TB diagnostic and treatment facilities at the periphery level is imperative to reduce diagnostic delay and expedite TB treatment.
authors.affiliation: Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Division of Infectious Disease Control, PO Box 4404, Nydalen, 0403 Oslo, Norway. yimsolo@yahoo.com.
authors.forename: Solomon A
authors.initials: SA
authors.lastname: Yimer
authors.forename: Gunnar A
authors.initials: GA
authors.lastname: Bjune
authors.forename: Carol
authors.initials: C
authors.lastname: Holm-Hansen
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D005002:Ethiopia; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012424:Rural Population; D013995:Time; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult