Causes of delay in diagnosis of pulmonary tuberculosis in patients attending a referral hospital in Western Kenya

Abstract

Objective: To determine the length of delays from onset of symptoms to initiation of treatment of pulmonary tuberculosis (PTB). Design: Cross-sectional study. Setting: Chest/TB clinic, Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Subjects: Newly diagnosed smear positive pulmonary tuberculosis (PTB) patients. Results: Two hundred and thirty patients aged between 12 and 80 (median; 28.5) years were included in the study. They comprised 148 (64.3%, median 30 years) males and 82 (35.7%, median 28 years) females. One hundred and two (44%) came from urban and 128 (56%) came from rural setting covering a median distance of 10 (range 0-100) kilometres and paying Kshs 20 (range 0-200) to facility. Cough was the commonest symptom reported by 228 (99.1%) of the patients followed by chest pain in 214 (80%). The mean patient delay was 11 ± 17 weeks (range: 1-78 weeks) with no significant difference between males and females, the mean system delay was 3 ± 5 weeks (range: 0-39 weeks). The median patient, health systems and total delays were 42, 2, and 44 days respectively for all the patients. Marital status, being knowledgeable about TB, distance to clinic and where help is sought first had significant effect on patient delay. Conclusion: Patient delay is the major contributor to delay in diagnosis and initiation of treatment of PTB among our patients. Therefore TB control programmes in this region must emphasise patient education regarding symptoms of tuberculosis and timely health seeking behaviour.