title: Delays in diagnosis and treatment of pulmonary tuberculosis in Wakiso and Mukono districts, Uganda.
abstract: BACKGROUND
  Delay in tuberculosis (TB) diagnosis may worsen the disease and increase TB transmission. Therefore, timely diagnosis and treatment is critical in TB control. We aimed to assess the treatment delay of pulmonary TB and its determinants in two Ugandan districts where TB infection control (TBIC) guidelines were formerly implemented.
  
  
  METHODS
  A facility based cross-sectional study was conducted in Mukono and Wakiso districts. Adult pulmonary TB patients within three months of initiating treatment were included in the study. Delays were categorized into unacceptable patient delay (more than 3 weeks from the onset of cough and the first consultation with a health care provider), health service (more than one week from the first consultation to the initiation of TB treatment) and total delay (more than 4 weeks since the onset of cough). The prevalences as well as predictors for the three delays were determined.
  
  
  RESULTS
  We enrolled 158 sputum positive patients. Unacceptable patient delay was noted in 91 (58%) patients, a health service delay in 140 (88%) patients and a total delay in 140 (90%) patients. An independent predictor for patient delay was male gender (p < 0.001). First visiting a non-public health facility (p = 0.001) was an independent predictor of health service delay.
  
  
  CONCLUSIONS
  There is still a significant TB diagnosis and treatment delay in Uganda. Most of the delay was caused by health system delay in the non-public health care sector. There is need for TB advocacy in the community, training of health workers in TBIC and strengthening public-private partnerships in TB control.
authors.affiliation: Makerere University School of Public Health, Kampala, Uganda. eburegyeya@musph.ac.ug.
authors.forename: Esther
authors.initials: E
authors.lastname: Buregyeya
authors.forename: Bart
authors.initials: B
authors.lastname: Criel
authors.forename: Fred
authors.initials: F
authors.lastname: Nuwaha
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010342:Patient Acceptance of Health Care; D013183:Sputum / Q000382:microbiology; D061665:Time-to-Treatment; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy*; D014454:Uganda; D055815:Young Adult