title: Determinants of health system delay at public and private directly observed treatment, short course facilities in Lagos State, Nigeria: A cross-sectional study.
abstract: Despite several studies on health system delay (HSD) among tuberculosis (TB) patients in Nigeria, no study has compared HSD in private and public health facilities. This study assessed the determinants of HSD in public and private health facilities offering the directly observed treatment, short course (DOTS).
  
  
  
  A descriptive cross-sectional study was conducted. A total of 470 new smear-positive TB patients aged 14years and older were consecutively recruited between October 1, 2012, and December 31, 2012, from 34 (23 public and 11 private) DOTS facilities that offered treatment and microscopy services. Mann-Whitney U test and logistic regression were used to assess the determinants of HSD.
  
  
  
  The median HSD was longer at public DOTS facilities (14days; interquartile range [IQR] 10-21days) than private DOTS facilities (12.5days; IQR 10.0-14.0days, p=.002). Age and human immunodeficiency virus status were determinants of HSD at the public DOTS facilities, whereas sex and income were determinants of HSD at the private DOTS facilities. TB patients who first visited a nonhospital facility were over four times more likely (odds ratio 4.12; 95% confidence interval 2.25-7.54) to have prolonged HSD than those who first visited the government hospital when they first developed the symptoms of TB after controlling for other factors in the model.
  
  
  
  Determinants of HSD at the public and private DOTS facilities vary. Strategies to reduce HSD at both public and private DOTS facilities in Lagos State, Nigeria, are urgently needed.
authors.affiliation: Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. Electronic address: drolus_adejumo@yahoo.com.
authors.forename: Olusola Adedeji
authors.initials: OA
authors.lastname: Adejumo
authors.affiliation: Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.
authors.forename: Olusoji James
authors.initials: OJ
authors.lastname: Daniel
authors.affiliation: Department of Medical Services, Central Bank of Nigeria, Lagos, Nigeria.
authors.forename: Andrew Folarin
authors.initials: AF
authors.lastname: Otesanya
authors.affiliation: Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Ogun State, Nigeria.
authors.forename: Esther Ngozi
authors.initials: EN
authors.lastname: Adejumo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D006268:Health Facilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D017149:Private Sector; D017150:Public Sector; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
keywords: Determinants; Directly observed treatment; Health system delay; Lagos; Short course; Tuberculosis