Demissie Meaza, Lindtjorn Bernt, Berhane Yemane
National Tuberculosis and Leprosy Control Programme, Addis Ababa, Ethiopia.
BMC Public Health. 2002 Sep 25;2:23. doi: 10.1186/1471-2458-2-23.
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).
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.
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.
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.
结核病诊断延迟可能会使病情恶化，增加死亡风险，并加剧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（患者延迟）之间的延迟时长，以及就诊与结核病诊断（卫生服务延迟）之间的延迟时长。
1998年8月1日至12月31日在亚的斯亚贝巴开展了一项涵盖所有公共卫生中心的横断面调查。在诊断当天使用结构化问卷对患者进行访谈。
对700例肺结核患者进行了研究。患者延迟的中位数为60天，平均为78.2天。涂片阳性患者中，延迟就诊和较早就诊的患者在社会人口学因素方面无显著差异。然而，涂片阴性患者在从家到医疗机构的距离以及对结核病治疗的了解方面存在显著差异。卫生服务延迟较低（中位数6天；平均9.5天），涂片阳性患者的延迟明显低于涂片阴性患者。较长的卫生服务延迟（超过15天的延迟）与距离远有关。
结核病患者在诊断前的时间较长，这似乎与患者对结核病治疗的知识不足以及到卫生中心的距离有关。建议进一步将结核病服务去中心化，采用主动病例发现的一些组成部分，并提高公众对该疾病的认识以增加服务利用率。
