Delay and discontinuity--a survey of TB patients' search of a diagnosis in a diversified health care system

Int J Tuberc Lung Dis. 1999 Nov;3(11):992-1000.


Setting: Ho Chi Minh City (HCMC), Vietnam.

Objectives: To describe delay to diagnosis; to compare diagnostic procedures and referral routines used by private and public health care providers; and to examine associations between contact with various types of providers and risk of delay to TB diagnosis.

Design: Cross-sectional survey of new patients in the National Tuberculosis Programme (NTP). Retrospective assessment of health seeking and diagnostic procedures used by previously contacted health care providers.

Results: Four weeks after first symptom, 81% of patients had sought help outside the household. Four weeks after first health care contact, 47% had been diagnosed with TB. Private physicians used X-rays, sputum smears, and referrals significantly less often than public health care providers. Patients who had turned first to a private pharmacy, a private physician or a public hospital were significantly more likely to have a long provider delay than those who turned first to the NTP.

Conclusion: Delay to diagnosis of TB in HCMC is due more to inability among health care providers to detect TB than to under-utilisation of health care services. Diagnostic procedures need to be improved and referral chains need to be strengthened in HCMC, particularly among private providers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Continuity of Patient Care*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Private Sector
  • Referral and Consultation
  • Time Factors
  • Tuberculosis, Pulmonary / diagnosis*
  • Vietnam