Delay in diagnosis of pulmonary tuberculosis at a primary health clinic in Vitoria, Brazil

作者：Maciel E L N^*; Golub J E; Peres R L; Hadad D J; Favero J L; Molino L P; Bae J W; Moreira C M; Detoni V do V; Vinhas S A; Palaci M; Dietze R

来源：International Journal of Tuberculosis and Lung Disease, 2010, 14(11): 1403-1410.

• tuberculosis
• epidemiology
• delayed diagnosis

SETTING: Primary health clinics in Vitoria, Espirito Santo, Brazil.
OBJECTIVE: To identify risk factors associated with patient and health care delays among patients seeking care at primary health clinics.
METHODS: A prospective study among tuberculosis (TB) patients diagnosed in Vitoria between 1 January 2003 and 30 December 2007. A questionnaire ascertained the date of onset and duration of TB symptoms and medical records were reviewed. Between-group distributions of delay were compared and multivariate logistic regression was performed.
RESULTS: Of 304 patients, 296 (97%) reported at least one TB symptom presenting for the first time to a qualified health service; 244 (80%) reported cough > 3 weeks. Median health care delay was 30 days (range 5-68), and median total delay was 110 days (range 26-784). Multivariate analysis revealed any cough (ORadi 7.35, 95% CI 2.40-22.5) and weight at TB diagnosis < 60 kg (ORadi 5.92, 95% CI 1.83-19.1) to be associated with patient delay of >= 30 days. Factors increasing risk of prolonged delay (>= 90 days) were age >= 30 years (ORadi 1.93, 95% CI 1.09-3.43) and chest pain (ORadi 2.42, 95% CI 1.29-4.53).
CONCLUSION: Improving health care workers' education regarding TB symptoms and implementing active case finding in targeted populations may reduce delays.

• 出版日期2010-11