Health service delay and associated factors among pulmonary tuberculosis patients presenting to Mulago Hospital: a cross sectional study.

Abstract

Delay in the diagnosis of pulmonary tuberculosis (PTB) is common in many countries in sub-Saharan Africa. Timely diagnosis of active TB is particularly crucial to minimise not only morbidity and mortality in the community, but also nosocomial transmission in health care facilities. Health service factors that lead to health service delay (delay in diagnosis and initiation of treatment) in the health facilities need to be elucidated so that appropriate interventions are instituted to reduce delay and nosocomial transmission of TB. OBJECTIVE: The objective of the present study was to determine health service delay in the diagnosis and initiation of treatment and its associated factors among PTB patients presenting to the national tuberculosis referral treatment centre, Mulago hospital. METHODS: A Cross-sectional study, with both descriptive and analytical components was conducted. All pulmonary TB patients presenting at the TB treatment centre Mulago hospital that fulfilled the selection criteria during the study period between March and May 2009 were enrolled. Using consecutive sampling method, patients with PTB were enrolled and interviewed using a semi-structured questionnaire. Data was double entered into Epi-data version 3.1 and analysed using SPSS version 11.0. RESULTS: Two hundred and sixty six (266) newly diagnosed patients with PTB were enrolled. Factors associated with health service delay were; female (OR=0.51, C1=0.28-0.94), no weight loss (OR=2.41, C1=1.25-4.62), Out-patients (OR=2.60, C1=1.42-4.77), and sputum smear negative (OR=4.84, C1=2.48, C1=2.48-9.43). Other factors such as age, ward patients was admitte4d to, level of education, etc were not significantly associated with health service delay. CONCLUSION: This study found that 174(65.4%) of the respondents experienced health service delay in diagnosis and initiation of treatment. The health service factors associated with the delay were patients being female, having no weight loss and being sputum smear negative. Furthermore, insufficient and irregular supply of anti-TB drugs, initial treatment with non-TB drugs (antibiotic treatment), inadequate sputum containers and reagents, inadequate space and poor staffing levels were also significant associated with health service delay.