BMC Infect Dis. 2013 Apr 8;13:168. doi: 10.1186/1471-2334-13-168.
Tuberculosis (TB) is still a great challenge to public health in sub-Saharan Africa. Most transmissions occur between the onset of coughing and initiation of treatment. Delay in diagnosis is significant to disease prognosis, thus early diagnosis and prompt effective therapy represent the key elements in controlling the disease. The objective of this study was to investigate the factors influencing the patient delay and the health system delay in TB diagnosis in Angola.
On a cross-sectional study, 385 TB patients who visited 21 DOTS clinics in Luanda were included consecutively. The time from the onset of symptoms to the first consultation of health providers (patients' delay) and the time from the first consultation to the date of diagnosis (health system's delay) were analysed. Bivariate and logistics regression were applied to analyse the risk factors of delays.
The median total time elapsed from the onset of symptoms to diagnosis was 45 days (interquartile range [IQR]: 21-97 days). The median patient delay was 30 days (IQR: 14-60 days), and the median health care system delay was 7 days (IQR: 5-15 days). Primary education (AOR = 1.75; CI [95%] 1.06-2.88; p <0.029) and the health centre of the first contact differing from the DOTS centre (AOR = 1.66; CI [95%] 1.01-2.75; p <0.046) were independent risk factors for patient delay >4 weeks. Living in a suburban area (AOR = 2,32; CI [95%] 1.21-4.46; p = 0.011), having a waiting time in the centre >1 hour (AOR = 4.37; CI [95%] 1.72-11.14; p = 0.002) and the health centre of the first contact differening from the DOTS centre (AOR = 5.68; CI [95%] 2.72-11,83; p < 0,00001) were factors influencing the system delay.
The results indicate that the delay is principally due to the time elapsed between the onset of symptoms and the first consultation. More efforts should be placed in ensuring the availability of essential resources and skills in all healthcare facilities other than the DOTS centres, especially those located in suburban areas.
结核病（TB）仍然是撒哈拉以南非洲公共卫生的巨大挑战。大多数传播发生在咳嗽开始和治疗开始之间。诊断的延迟对疾病的预后有重大影响，因此早期诊断和及时有效的治疗是控制疾病的关键要素。本研究旨在探讨安哥拉结核病诊断中患者延迟和卫生系统延迟的影响因素。
在一项横断面研究中，连续纳入了 385 名在罗安达 21 个 DOTS 诊所就诊的 TB 患者。分析了从症状出现到首次咨询卫生提供者（患者延迟）和从首次咨询到诊断日期（卫生系统延迟）的时间。应用双变量和逻辑回归分析延迟的危险因素。
从症状出现到诊断的总时间中位数为 45 天（四分位距 [IQR]：21-97 天）。患者延迟的中位数为 30 天（IQR：14-60 天），卫生系统延迟的中位数为 7 天（IQR：5-15 天）。小学教育（AOR = 1.75；CI [95%] 1.06-2.88；p <0.029）和首次接触的医疗中心与 DOTS 中心不同（AOR = 1.66；CI [95%] 1.01-2.75；p <0.046）是患者延迟 >4 周的独立危险因素。居住在郊区（AOR = 2.32；CI [95%] 1.21-4.46；p = 0.011）、中心等待时间 >1 小时（AOR = 4.37；CI [95%] 1.72-11.14；p = 0.002）和首次接触的医疗中心与 DOTS 中心不同（AOR = 5.68；CI [95%] 2.72-11.83；p <0.00001）是影响系统延迟的因素。
结果表明，延迟主要是由于症状出现和首次咨询之间的时间流逝所致。应更加努力确保除 DOTS 中心以外的所有医疗保健设施（特别是位于郊区的设施）具备基本资源和技能。
