title: Diagnosis delay and duration of hospitalisation of patients with Buruli ulcer in Nigeria.
abstract: Delayed diagnosis of Buruli ulcer can worsen clinical presentation of the disease, prolong duration of management, and impose avoidable additional costs on patients and health providers. We investigated the profile, delays in diagnosis, duration of hospitalisation, and associated factors among patients with Buruli ulcer in Nigeria.
  
  
  
  This was a prospective cohort study of patients with Buruli ulcer who were identified from a community-based survey. Data on the patients' clinical profile, delays in diagnosis and duration of hospitalisation were prospectively collected.
  
  
  
  Of 145 patients notified, 125 (86.2%) were confirmed by one or more laboratory tests (81.4% by PCR). The median age of the patients was 20 years, 88 (60.7%) were >15years old and 85 (58.6%) were females. In addition, 137 (94.5%) were new cases, 119 (82.1%) presented with ulcers and 110 (75.9%) had lower limb lesions. The mean time delay to diagnosis was 50.6 (±101.9) weeks. The mean duration of hospitalisation was 108 (±60) days. Determinants of time delay to diagnosis were higher disease category (p=0.001) and laboratory confirmation of disease (p=0.02). Determinants of longer hospitalisation were; multiple lesions (p=0.035), and having functional limitation at diagnosis and undertaking surgery (p=0.003).
  
  
  
  Patients with Buruli ulcer have very long time delays to diagnosis and long hospitalisation during treatment. This calls for early case-finding and improved access to Buruli ulcer services in Nigeria.
authors: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors: Anthony O
authors: AO
authors: Meka
authors: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors: Joseph N
authors: JN
authors: Chukwu
authors: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors: Charles C
authors: CC
authors: Nwafor
authors: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors: Daniel C
authors: DC
authors: Oshi
authors: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors: Nelson O
authors: NO
authors: Madichie
authors: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors: Ngozi
authors: N
authors: Ekeke
authors: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors: Moses C
authors: MC
authors: Anyim
authors: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors: Chukwuka
authors: C
authors: Alphonsus
authors: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors: Obinna
authors: O
authors: Mbah
authors: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors: Glory C
authors: GC
authors: Uzoukwa
authors: St Benedict's Tuberculosis & Leprosy Rehabilitation Hospital, Ogoja, Cross River State, Nigeria.
authors: Martin
authors: M
authors: Njoku
authors: St Benedict's Tuberculosis & Leprosy Rehabilitation Hospital, Ogoja, Cross River State, Nigeria.
authors: Kentigern
authors: K
authors: Ntana
authors: Department of Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria ukwajakingsley@yahoo.co.uk.
authors: Kingsley N
authors: KN
authors: Ukwaja
mesh_terms: D000293:Adolescent; D000328:Adult; D054312:Buruli Ulcer / Q000175:diagnosis* / Q000191:economics / Q000382:microbiology / Q000628:therapy; D002648:Child; D057210:Delayed Diagnosis / Q000009:adverse effects / Q000191:economics; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D019911:Mycobacterium ulcerans / Q000302:isolation & purification; D009549:Nigeria / Q000453:epidemiology; D016133:Polymerase Chain Reaction / Q000191:economics; D011446:Prospective Studies; D012424:Rural Population; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Care-seeking; Delays; Diagnosis; Mycobacterium ulcerans; Nigeria; Treatment