Lawn S D, Afful B, Acheampong J W
The Department of Medicine, School of Medical Sciences, University of Science and Technology, Kumasi, Ghana, West Africa.
Int J Tuberc Lung Dis. 1998 Aug;2(8):635-40.
Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana, West Africa.
To determine the factors affecting the delay from the onset of symptoms of pulmonary tuberculosis until the initiation of treatment.
A retrospective questionnaire survey of 100 adults with newly diagnosed smear-positive pulmonary tuberculosis.
The median total delay in diagnosis was 4 months (mean = 7.7), and total delay exceeded 6 months in 44% of patients. Total delay was strongly associated with rural residence (P = 0.001). The median doctor delay from the first consultation until diagnosis was double the median patient delay in initial presentation (8 weeks versus 4 weeks). Doctor delay was significantly increased in females, rural patients, and among those needing hospital admission. Increased doctor delay was strongly correlated with rates of failure to perform sputum microscopy (r = 0.99), low rates of diagnosis, and was seen particularly among private practitioners and rural government institutions.
Delays in the diagnosis of pulmonary tuberculosis are prolonged in Kumasi, Ghana, with a frequently lengthy doctor delay. The new National Tuberculosis Programme is decentralising the diagnosis and management of tuberculosis, with the introduction of widely available sputum microscopy and rigorous training of health personnel. This should help to reduce doctor delay and thereby improve tuberculosis control.
西非加纳库马西的科姆福·阿诺克耶教学医院内科。
确定影响从肺结核症状出现到开始治疗延迟的因素。
对100例新诊断为涂片阳性肺结核的成年人进行回顾性问卷调查。
诊断的总延迟中位数为4个月（平均 = 7.7），44%的患者总延迟超过6个月。总延迟与农村居住密切相关（P = 0.001）。从首次就诊到诊断的医生延迟中位数是患者首次就诊延迟中位数的两倍（8周对4周）。女性、农村患者以及需要住院的患者中医生延迟明显增加。医生延迟增加与痰涂片镜检未开展率高（r = 0.99）、诊断率低密切相关，在私人执业医生和农村政府机构中尤为明显。
加纳库马西肺结核诊断延迟时间延长，医生延迟常常很长。新的国家结核病规划正在将结核病的诊断和管理权力下放，引入广泛可用的痰涂片镜检并对卫生人员进行严格培训。这应有助于减少医生延迟，从而改善结核病控制。
