Long delays and missed opportunities in diagnosing smear-positive pulmonary tuberculosis in Kampala, Uganda: a cross-sectional study.
Long delays and missed opportunities in diagnosing smear-positive pulmonary tuberculosis in Kampala, Uganda: a cross-sectional study.
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DOI：
10.1371/journal.pone.0014459
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发表时间：
2010-12-29
期刊：
影响因子：
3.7
通讯作者：
Cobelens F
中科院分区：
文献类型：
--
作者：
Sendagire I;Schim Van der Loeff M;Mubiru M;Konde-Lule J;Cobelens F
早期发现和治疗结核病病例是成功控制结核病的标志。我们在乌干达坎帕拉市的公共初级卫生机构进行了一项横断面研究，以量化肺结核（PTB）患者的诊断延迟，评估相关因素，并描述患者寻求医疗保健的轨迹。对登记接受治疗的新涂片阳性肺结核患者（≥15年）进行半结构化访谈。2007年4月至2008年4月，253名患者接受了研究。总延迟中位数为8周（IQR 4 - 12），患者延迟中位数为4周（四分位间距[IQR] 1-8），卫生服务延迟中位数为4周（IQR 2-8）。61/253例（24.1%）患者总延迟时间长（>14周），71/242例（29.3%）患者总延迟时间长（>6周），47/242例（19.4%）患者总延迟时间长（>8周）。知道结核病可治愈的患者不太可能出现长时间的总延迟（调整优势比[aOR] 0.28; 95%CI 0.11-0.73）和长时间的患者延迟（aOR 0.36; 95%CI 0.13-0.97）。女性（aOR 1.98; 95%CI 1.06-3.71）、在现居住地居住超过5年（aOR 2.24 95%CI 1.18-4.27）和之前接受过艾滋病毒检测（aOR 3.72; 95%CI 1.42-9.75）与长期卫生服务延误相关。医疗服务延误占总延误的50%。91%（231）的患者在确诊前曾访问过一个或多个卫生保健提供者，平均（中位数）访问4次（范围1-30）。除4名患者外，所有患者在诊断出结核病时都出现了全身性症状。在坎帕拉，结核病患者的诊断延误是常见和长期的。这反映出患者在就医前等待时间过长，卫生服务部门等到出现全身症状后才进行痰涂片检查；这导致错过了诊断机会。
Early detection and treatment of tuberculosis cases are the hallmark of successful tuberculosis control. We conducted a cross-sectional study at public primary health facilities in Kampala city, Uganda to quantify diagnostic delay among pulmonary tuberculosis (PTB) patients, assess associated factors, and describe trajectories of patients' health care seeking. Semi-structured interviews with new smear-positive PTB patients (≥15 years) registered for treatment. Between April 2007 and April 2008, 253 patients were studied. The median total delay was 8 weeks (IQR 4–12), median patient delay was 4 weeks (inter-quartile range [IQR] 1–8) and median health service delay was 4 weeks (IQR 2–8). Long total delay (>14 weeks) was observed for 61/253 (24.1%) of patients, long health service delay (>6 weeks) for 71/242 (29.3%) and long patient delay (>8 weeks) for 47/242 (19.4%). Patients who knew that TB was curable were less likely to have long total delay (adjusted Odds Ratio [aOR] 0.28; 95%CI 0.11–0.73) and long patient delay (aOR 0.36; 95%CI 0.13–0.97). Being female (aOR 1.98; 95%CI 1.06–3.71), staying for more than 5 years at current residence (aOR 2.24 95%CI 1.18–4.27) and having been tested for HIV before (aOR 3.72; 95%CI 1.42–9.75) was associated with long health service delay. Health service delay contributed 50% of the total delay. Ninety-one percent (231) of patients had visited one or more health care providers before they were diagnosed, for an average (median) of 4 visits (range 1–30). All but four patients had systemic symptoms by the time the diagnosis of TB was made. Diagnostic delay among tuberculosis patients in Kampala is common and long. This reflects patients waiting too long before seeking care and health services waiting until systemic symptoms are present before examining sputum smears; this results in missed opportunities for diagnosis.
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