title: Factors associated with the length of delay with tuberculosis diagnosis and treatment among adult tuberculosis patients attending at public health facilities in Gondar town, Northwest, Ethiopia.
abstract: Early diagnosis and prompt treatment is essential for an effective tuberculosis (TB) control program. However, significant proportion of cases remains undiagnosed and untreated. Delay in diagnosis and treatment increases transmission. Hence, the study assessed the length of delay and associated factors with tuberculosis diagnosis and treatment among adults attending public health facilities in Gondar town, Northwest Ethiopia.
  
  
  
  An institution based cross-sectional study was conducted from February to May, 2016. A total of 296 adults who came to health facilities for treatment for pulmonary TB from February to May, 2016, were included in the study. Data were collected using a structured questionnaire through interviewing and record review, cleaned, coded, and entered into Epi-info version 3.5.3, and transferred into SPSS version 20.0 for further statistical analysis. A p-value of less than 0.05 at multiple linear regression analysis was considered statistically significant.
  
  
  
  The mean duration of the total delay (in days) for tuberculosis diagnosis and initiation of treatment was 41.6 days (SD = 16.6). In this study, the mean duration of patient delay and the median health system delay were 33.9 days (SD = 14) and 5 days (IQR = 4-7), respectively. Total delay for TB diagnosis and treatment was shorter among HIV positive people (β:-12.62, 95% CI: -20.72,-4.53). Longer patient delay was noted among rural dwellers (β: 8.0, 95% CI: 5.26, 10.75); increased household income (β:-0.006, 95% CI: -0.008,-0.004) was associated with a shorter delay. Health system delay was positively associated with seeking care from more than one health care providers (β: 0.28, 95% CI: 0.23, 0.34) and seeking initial care from primary level health care facilities (β: 0.10, 95% CI: 0.07, 0.13).
  
  
  
  In this study, the majority of patients faced delayed in seeking health care and continued as sources of infection. Longer days of delay for TB diagnosis and treatment were noted among rural residents, who seek health care from informal care providers, and receive initial care from primary level health care facilities. In contrast, the length of delay for TB diagnosis and treatment was shorter among HIV positive people and individuals with increased household income. Therefore, public awareness on the symptoms of tuberculosis and seeking health care early is essential. Moreover, early diagnosis and treatment, especially among the rural dwellers and the poor should be focused.
authors.affiliation: Department of Internal medicine, University of Gondar, Gondar, Ethiopia.
authors.forename: Selamsew
authors.initials: S
authors.lastname: Bogale
authors.affiliation: Department of Internal medicine, University of Gondar, Gondar, Ethiopia.
authors.forename: Ermias
authors.initials: E
authors.lastname: Diro
authors.affiliation: Department of Health Informatics, University of Gondar, Gondar, Ethiopia.
authors.forename: Atsede Mazengia
authors.initials: AM
authors.lastname: Shiferaw
authors.affiliation: Department of Epidemiology and Biostatistics, University of Gondar, 196, Gondar, Ethiopia. melaku98@gmail.com.
authors.forename: Melaku Kindie
authors.initials: MK
authors.lastname: Yenit
mesh_terms: D000293:Adolescent; D000328:Adult; D060085:Coinfection; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000517:prevention & control / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D012424:Rural Population; D011795:Surveys and Questionnaires; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
keywords: 2016; Delay; Northwest Ethiopia; TB diagnosis and treatment