Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia
Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia
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DOI：
10.1186/1471-2458-2-23
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发表时间：
2002-09-25
影响因子：
4.5
通讯作者：
Berhane, Y
中科院分区：
文献类型：
--
作者：
Demissie, M;Lindtjorn, B;Berhane, Y
背景：结核病的诊断延误可能使病情恶化，增加死亡风险，并增加结核病在社区中的传播。本研究旨在确定症状出现与患者首次就诊之间的延迟长度（患者延迟），以及就诊与结核病诊断之间的延迟长度（卫生服务延迟）。方法：1998年8月1日至12月31日在亚的斯亚贝巴的所有公共卫生中心进行了横断面调查。于诊断当日采用结构化问卷对患者进行访谈。结果：对700例肺结核患者进行了调查。患者延迟的中位数为60天，平均为78.2天。在那些延迟和早来涂片阳性的社会人口因素没有显著差异。然而，涂片阴性人群从家到卫生机构的距离和对结核病治疗的了解程度存在显著差异。保健服务延误较低（中位数为6天；平均为9.5天），涂片阳性患者的延误明显低于涂片阴性患者。医疗服务延误时间较长（延误超过15天）与距离较远有关。结论：结核病患者诊断前的时间较长，这似乎与患者对结核病治疗的认识不足以及到卫生中心的距离有关。建议进一步下放结核病服务，利用主动发现病例的某些组成部分，并提高公众对该疾病的认识，以提高服务的利用率。
Background: Delay in the diagnosis of tuberculosis may worsen the disease, increase the risk of death and enhance tuberculosis transmission in the community. This study aims to determine the length of delay between the onset of symptoms and patients first visit to health care ( patient delay), and the length of delay between health care visit and the diagnosis of tuberculosis ( health service delay).Methods: A cross sectional survey that included all the public health centres was conducted in Addis Ababa from August 1 to December 31 1998. Patients were interviewed on the same day of diagnosis using structured questionnaire.Results: 700 pulmonary TB patients were studied. The median patient delay was 60 days and mean 78.2 days. There was no significant difference in socio-demographic factors in those who delayed and came earlier among smear positives. However, there was a significant difference in distance from home to health institute and knowledge about TB treatment among the smear negatives. The health service delay was low ( median 6 days; mean 9.5 days) delay was significantly lower in smear positives compared to smear negatives. Longer health service delay ( delay more than 15 days) was associated with far distance.Conclusions: The time before diagnosis in TB patients was long and appears to be associated with patient inadequate knowledge of TB treatment and distance to the health centre. Further decentralization of TB services, the use of some components of active case finding, and raising public awareness of the disease to increase service utilization are recommended.