title: Pulmonary tuberculosis: Diagnostic delay in Tunisia.
abstract: OBJECTIVE
  Early diagnosis and prompt effective therapy are crucial to fight against tuberculosis (TB), particularly in regions with a high prevalence. We aimed to evaluate TB diagnostic delays and identify the associated risk factors.
  
  
  METHODS
  We conducted a survey in various health facilities in Tunisia between March 24th and October 30th, 2014. We included all patients aged ≥ 18 years who presented with pulmonary TB (PTB) and who had been initiated on an anti-TB treatment. We evaluated the time between respiratory symptom onset and treatment initiation. Treatment delays were divided into three categories: delays due to the patient, to the healthcare system, and overall delays.
  
  
  RESULTS
  We included 352 patients in the study (242 men and 110 women). The mean age was 42.2 years±17.7. The median time from symptom onset to treatment initiation was 52.56 days. Patient delays were longer for men, for patients presenting with alcohol dependence, and for patients who already knew they were sick. Healthcare system delays were associated with older age, female patients, patients consulting a private physician, and outpatients.
  
  
  CONCLUSIONS
  TB symptoms should be better explained to the population and healthcare professionals should be better trained to both reduce such delays and initiate treatment as early as possible.
authors.affiliation: Service de pneumologie, hôpital Charles-Nicolle, 1009, Baab Saadoun, Tunis, Tunisia. Electronic address: jihenbenamar@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Ben Amar
authors.affiliation: Service d'épidémiologie, institut Salah Azaiz, Tunis, Tunisia.
authors.forename: M
authors.initials: M
authors.lastname: Hassairi
authors.affiliation: Service d'épidémiologie, institut Salah Azaiz, Tunis, Tunisia.
authors.forename: N
authors.initials: N
authors.lastname: Ben Salah
authors.affiliation: Service d'épidémiologie, institut Salah Azaiz, Tunis, Tunisia.
authors.forename: R
authors.initials: R
authors.lastname: Charfi
authors.affiliation: Service d'épidémiologie, institut Salah Azaiz, Tunis, Tunisia.
authors.forename: F
authors.initials: F
authors.lastname: Tritar
authors.affiliation: Service d'épidémiologie, institut Salah Azaiz, Tunis, Tunisia.
authors.forename: R
authors.initials: R
authors.lastname: Fourati
authors.affiliation: Service d'épidémiologie, institut Salah Azaiz, Tunis, Tunisia.
authors.forename: D
authors.initials: D
authors.lastname: Gamara
authors.affiliation: Service de pneumologie, hôpital Charles-Nicolle, 1009, Baab Saadoun, Tunis, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Aouina
authors.affiliation: Service de pneumologie, hôpital Charles-Nicolle, 1009, Baab Saadoun, Tunis, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Bouacha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*; D014416:Tunisia; D055815:Young Adult
keywords: Diagnosis; Diagnostic; Diagnostic delay; Retard diagnostique; Tuberculose; Tuberculosis