title: Factors associated with DELAY in diagnosis among tuberculosis patients in Hohoe Municipality, Ghana.
abstract: BACKGROUND
  Any delay in diagnosis and consequently treatment of TB patients not only increases the infectivity of the disease in the community, but may also lead to more advance disease state, which may result in more complications and expose patients to higher risk of death. The aim of this study was to assess delays in diagnosing new TB patients and the factors associated with these delays in Hohoe Municipality of Ghana.
  
  
  METHODS
  A cross sectional study was carried out among 73 new TB Patients, 15 years or older, registered between 1st June, 2013 and 31st May, 2014 in Hohoe Municipality. Questionnaires were administered to patients to evaluate factors related to delay by patients in seeking care, delays at healthcare facilities, and total diagnostic delay. Logistic regression was used to determine the factors associated with patient delay (>30 days), healthcare services delay (>15 days), and total delay (>45 days).
  
  
  RESULTS
  The median total delay was 104 days (inter-quartile range (IQR):17-191). The median patient delay was 59 days (IQR: 5-123), and the median healthcare services delay was 45 days (IQR: 38-128). Not medically insured (AOR = 6.12; 95 % CI: 1.26-29.88; P < 0.025) and perceived stigma (AOR = 5.30; 95 % CI: 1.33-21.18; P < 0.018) were risk factors associated with prolonged patient delay. Multiple healthcare contact following signs and symptoms (AOR = 10.26; 95 %CI: 2.95-35.72; P < 0.0001) was the only risk factor associated with prolonged healthcare services delay.
  
  
  CONCLUSIONS
  There is a considerable delay in TB case detection mainly due to patients delay in seeking healthcare. The factors associated with patients' delay include lack of medical insurance, perceived stigma, and making multiple healthcare encounters. Health system strengthening towards decentralizing TB diagnosis and management, raising public awareness about the disease, training of healthcare providers, and collaborating with non-formal healthcare providers may reduce long delays in the management of TB.
authors.affiliation: Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana. ericusonline@yahoo.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Osei
authors.affiliation: Department of Epidemiology, School of Public Health, University of Ghana, Accra, Ghana. akweongo@gmail.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Akweongo
authors.affiliation: University of Health and Allied Sciences, Ho, Ghana. fred.binka@gmail.com.
authors.forename: Fred
authors.initials: F
authors.lastname: Binka
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D005869:Ghana; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult