DELAY IN THE DIAGNOSIS, NOTIFICATION AND INITIATION OF TREATMENT AND COMPLIANCE IN CHILDREN WITH TUBERCULOSIS

Setting: The mortality and morbidity from childhood tuberculosis may b e influenced by the delay from the time of first symptoms until the st art of and compliance with treatment. Objective: This study investigat ed these delay periods and the compliance with therapy in children wit h tuberculosis. Design: During the study period there were 49 children with probable and 123 with confirmed pulmonary tuberculosis (WHO crit eria). The mean period from first symptoms until presentation was 4.3 weeks, from presentation until notification 5 weeks and from notificat ion until therapy 0.9 weeks. 16% of children notified as having tuberc ulosis never received therapy. Significantly fewer children in the urb an squatter communities received therapy than in urban settled (P = 0. 02), rural agricultural (P = 0.0001) and rural settled (P = 0.09) comm unities. 12% of children did not complete their therapy. Conclusion: T he delay in presentation ('patient delay') was shorter than the delay in diagnosis ('doctor delay'). Failure to trace children and to comple te therapy was particularly likely to occur in urban squatter communit ies. Easier access to health care facilities may shorten the 'patient delay' while greater awareness of tuberculosis and proper investigatio n of children may shorten the 'doctor delay'.