PULMONARY TUBERCULOSIS - DIAGNOSTIC DELAY IN GHANAIAN ADULTS

SETTING: Department of Medicine, Komfo Anokye Teaching Hospital, Kumas i, Ghana, West Africa. OBJECTIVE: TO determine the factors affecting t he delay from the onset of symptoms of pulmonary tuberculosis until th e initiation of treatment. DESIGN: A retrospective questionnaire surve y of 100 adults with newly diagnosed smear-positive pulmonary tubercul osis. RESULTS: The median total delay in diagnosis was 4 months (mean = 7.7), and total delay exceeded 6 months in 44% of patients. Total de lay was strongly associated with rural residence (P = 0.001). The medi an doctor delay from the first consultation until diagnosis was double the median patient delay in initial presentation (8 weeks versus 4 we eks). Doctor delay was significantly increased in females, rural patie nts, and among those needing hospital admission. Increased doctor dela y was strongly correlated with rates of failure to perform sputum micr oscopy (r = 0.39), low rates of diagnosis, and was seen particularly a mong private practitioners and rural government institutions. CONCLUSI ON: Delays in the diagnosis of pulmonary tuberculosis are prolonged in Kumasi, Ghana, with a frequently lengthy doctor delay. The new Nation al Tuberculosis Programme is decentralising the diagnosis and manageme nt of tuberculosis, with the introduction of widely available sputum m icroscopy and rigorous training of health personnel. This should help to reduce doctor delay and thereby improve tuberculosis control.