Delay in diagnosis of pulmonary tuberculosis at a primary health clinic in Vitoria, Brazil

Int J Tuberc Lung Dis. 2010 Nov;14(11):1403-10.

Abstract

Setting: Primary health clinics in Vitoria, Espirito Santo, Brazil.

Objective: To identify risk factors associated with patient and health care delays among patients seeking care at primary health clinics.

Methods: A prospective study among tuberculosis (TB) patients diagnosed in Vitoria between 1 January 2003 and 30 December 2007. A questionnaire ascertained the date of onset and duration of TB symptoms and medical records were reviewed. Between-group distributions of delay were compared and multivariate logistic regression was performed.

Results: Of 304 patients, 296 (97%) reported at least one TB symptom presenting for the first time to a qualified health service; 244 (80%) reported cough > 3 weeks. Median health care delay was 30 days (range 5-68), and median total delay was 110 days (range 26-784). Multivariate analysis revealed any cough (OR(adj) 7.35, 95%CI 2.40-22.5) and weight at TB diagnosis < 60 kg (OR(adj) 5.92, 95%CI 1.83-19.1) to be associated with patient delay of ≥ 30 days. Factors increasing risk of prolonged delay (≥ 90 days) were age ≥ 30 years (OR(adj) 1.93, 95%CI 1.09-3.43) and chest pain (OR(adj) 2.42, 95%CI 1.29-4.53).

Conclusion: Improving health care workers' education regarding TB symptoms and implementing active case finding in targeted populations may reduce delays.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Brazil / epidemiology
  • Chest Pain / diagnosis
  • Chest Pain / etiology
  • Cough / diagnosis*
  • Cough / etiology
  • Delayed Diagnosis / statistics & numerical data*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Primary Health Care / statistics & numerical data
  • Prospective Studies
  • Risk Factors
  • Time Factors
  • Tuberculosis, Pulmonary / diagnosis*
  • Tuberculosis, Pulmonary / epidemiology