Delay in the Diagnosis and Treatment of New Smear-Positive Pulmonary Tuberculosis in Khartoum State, Sudan : Patient’s or Health System Phenomenon

Abstract

Background and Objectives: delay in the diagnosis and treatment of new smear-positive tuberculosis may complicate the course of disease, increase the risk of tuberculosis transmission in local domestics and community, and hamper the efforts of disease control. This study aimed to determine the magnitude of the total pre-treatment, patients, and health system periods among newly diagnosed smear-positive pulmonary tuberculosis patients in Khartoum State, Sudan.

Setting: The study was conducted in the primary health care facilities of Khartoum State and Sudan Council of Churches. A total of 17 tuberculosis management units constituted the site of our study.

Design: a cross-sectional multistage descriptive and analytical design survey was conducted in Khartoum State from August 20 to October 25, 2003. A semi-structured questionnaire was used for interviewing newly diagnosed smear-positive TB cases within a period of 5 weeks from their starting of treatment.

Results: a total of 253 new smear-positive TB cases were recruited to this study. The median patient-period was 21 days (µ 33.9 days). There were no significant associations between patient’s demographic and socio-economic characteristics and patient-period. Furthermore, there were no significant associations between patient’s delay and most of the symptoms of onset and presentation. However, patient-period was influenced by patients’ evaluation of their symptoms, and perceived accessibility difficulties. The median health system period was 21 days (µ 32.9 days). The health system period was influenced by patient’s choice between medical providers and TBMU and by the number of visits to medical providers. The median total pre-treatment period was 53 days (µ 66.8 days), and about 59% of the study population had pre-treatment period of more than one and half month. There were no gender differences in the magnitude of pre-treatment periods. However, gender differences were related to TBMU-period and frequencies of performing TB diagnostic investigations, reaching TB diagnosis, and prescribing anti-TB treatment by medical providers.

Conclusions: the total pre-treatment period was almost equally divided between the patients and the health system. Increase pubic awareness about tuberculosis with emphasis on severity of symptoms; dissemination of information about the available TB services in terms of locations of TBMU, free access to diagnosis and treatment, and efficacy of anti-TB treatment; establishment of a clear policy that regulates the relation between different health care facilities and formal TB services (TBMUs) will be successful measurement to decrease the delay in the diagnosis and treatment of tuberculosis and will enhance better TB control.