Patient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: A cross-sectional study

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dc.contributor.authorMeintjes, Graemeen_ZA
dc.contributor.authorSchoeman, Hennieen_ZA
dc.contributor.authorMorroni, Chelseaen_ZA
dc.contributor.authorWilson, Douglasen_ZA
dc.contributor.authorMaartens, Garyen_ZA
dc.date.accessioned2015-10-28T07:01:16Z
dc.date.available2015-10-28T07:01:16Z
dc.date.issued2008en_ZA
dc.description.abstractBACKGROUND: Delay in the diagnosis of tuberculosis (TB) results in excess morbidity and mortality, particularly among HIV-infected individuals. This study was conducted at a secondary level hospital serving communities with a high HIV prevalence in Cape Town, South Africa. The aim was to describe patient and provider delay in the diagnosis of TB in patients with suspected TB requiring admission, and to determine the risk factors for this delay and the consequences. METHODS: A cross-sectional study was conducted. Patients admitted who were TB suspects were interviewed using a structured questionnaire to assess history of their symptoms and health seeking behaviour. Data regarding TB diagnosis and outcome were obtained from the medical records. Bivariate associations were described using student's T-tests (for means), chi-square tests (for proportions), and Wilcoxon rank-sum tests (for medians). Linear regression models were used for multivariate analysis. RESULTS: One hundred twenty-five (125) patients were interviewed. In 104 TB was diagnosed and these were included in the analysis. Seventy of 83 (84%) tested were HIV-infected. Provider delay (median = 30 days, interquartile range (IQR) = 10.3-60) was double that of patient delay (median = 14 days, IQR = 7-30). Patients had a median of 3 contacts with formal health care services before referral. Factors independently associated with longer patient delay were male gender, cough and first health care visit being to public sector clinic (compared with private general practitioner). Patient delay [greater than or equal to] 14 days was associated with increased need for transfer to a TB hospital. Provider delay [greater than or equal to] 30 days was associated with increased mortality. CONCLUSION: Delay in TB diagnosis was more attributable to provider than patient delay, and provider delay was associated with increased mortality. Interventions to expedite TB diagnosis in primary care need to be developed and evaluated in this setting.en_ZA
dc.identifier.apacitationMeintjes, G., Schoeman, H., Morroni, C., Wilson, D., & Maartens, G. (2008). Patient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: A cross-sectional study. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14454en_ZA
dc.identifier.chicagocitationMeintjes, Graeme, Hennie Schoeman, Chelsea Morroni, Douglas Wilson, and Gary Maartens "Patient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: A cross-sectional study." <i>BMC Infectious Diseases</i> (2008) http://hdl.handle.net/11427/14454en_ZA
dc.identifier.citationMeintjes, G., Schoeman, H., Morroni, C., Wilson, D., & Maartens, G. (2008). Patient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: a cross-sectional study. BMC infectious diseases, 8(1), 72.en_ZA
dc.identifier.ris TY - Journal Article AU - Meintjes, Graeme AU - Schoeman, Hennie AU - Morroni, Chelsea AU - Wilson, Douglas AU - Maartens, Gary AB - BACKGROUND: Delay in the diagnosis of tuberculosis (TB) results in excess morbidity and mortality, particularly among HIV-infected individuals. This study was conducted at a secondary level hospital serving communities with a high HIV prevalence in Cape Town, South Africa. The aim was to describe patient and provider delay in the diagnosis of TB in patients with suspected TB requiring admission, and to determine the risk factors for this delay and the consequences. METHODS: A cross-sectional study was conducted. Patients admitted who were TB suspects were interviewed using a structured questionnaire to assess history of their symptoms and health seeking behaviour. Data regarding TB diagnosis and outcome were obtained from the medical records. Bivariate associations were described using student's T-tests (for means), chi-square tests (for proportions), and Wilcoxon rank-sum tests (for medians). Linear regression models were used for multivariate analysis. RESULTS: One hundred twenty-five (125) patients were interviewed. In 104 TB was diagnosed and these were included in the analysis. Seventy of 83 (84%) tested were HIV-infected. Provider delay (median = 30 days, interquartile range (IQR) = 10.3-60) was double that of patient delay (median = 14 days, IQR = 7-30). Patients had a median of 3 contacts with formal health care services before referral. Factors independently associated with longer patient delay were male gender, cough and first health care visit being to public sector clinic (compared with private general practitioner). Patient delay [greater than or equal to] 14 days was associated with increased need for transfer to a TB hospital. Provider delay [greater than or equal to] 30 days was associated with increased mortality. CONCLUSION: Delay in TB diagnosis was more attributable to provider than patient delay, and provider delay was associated with increased mortality. Interventions to expedite TB diagnosis in primary care need to be developed and evaluated in this setting. DA - 2008 DB - OpenUCT DO - 10.1186/1471-2334-8-72 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2008 T1 - Patient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: A cross-sectional study TI - Patient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: A cross-sectional study UR - http://hdl.handle.net/11427/14454 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14454
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-8-72
dc.identifier.vancouvercitationMeintjes G, Schoeman H, Morroni C, Wilson D, Maartens G. Patient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: A cross-sectional study. BMC Infectious Diseases. 2008; http://hdl.handle.net/11427/14454.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2008 Meintjes et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherHealth Knowledge, Attitudes, Practiceen_ZA
dc.subject.otherHIV Infectionsen_ZA
dc.subject.otherTuberculosisen_ZA
dc.titlePatient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: A cross-sectional studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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