Diagnostic delay is the time from the onset of tuberculosis (TB) symptoms to the start of treatment. Longer delays produce more serious illnesses and increase the risk of TB spread within the community. What factors increase diagnostic delay? How can TB control programmes reduce this interval?

Researchers from the University of Toronto, Canada, and the London School of Hygiene and Tropical Medicine investigated the socio-economic, gender and health service factors that affect diagnostic delay in Lusaka, Zambia. TB control programmes need new methods for reaching women and less educated people. Changes to public TB care services could also reduce diagnostic delay.

The study of 202 TB patients showed that the mean diagnostic delay is nine weeks. The average interval is longer for:

• women
• individuals with less than nine years of education
• people who are diagnosed with TB as an outpatient or have more than six TB-related health-seeking encounters
• those who visit a private doctor or traditional healer.

There are high rates of dual infection with HIV and TB in this population, and the stigma associated with HIV may deter patients, especially women, from seeking care.

Longer delays for women correspond to more lost work days and reduced income. TB is a great economic burden on patients, and there is a slight trend towards shorter delay for patients who have external financial assistance.

This study suggests that the effectiveness of TB control programmes could be improved by:

• understanding the special circumstances of women and the poorly-educated and maximising their access to services
• reducing transport and time costs by integrating TB screening services for women into existing primary healthcare or paediatric clinics
• producing health education materials emphasising that TB is curable
• educating traditional healers and private practitioners about TB diagnosis
• integrating private sector services into the public sector TB control programme by providing access to laboratory services and free treatment schemes
• addressing factors that discourage use of the public sector such as longer waiting times and less flexible personal service
• expanding communication skills training for local public health service providers.

Decentralisation of diagnosis from specialist hospital units to local health clinics would increase the number of TB health providers and reduce waiting times. However, decentralisation in Zambia has been limited by funding difficulties and lack of supervision and training of personnel at many clinics. This may offset the potential benefits of decentralisation for TB control.

Source(s):
'Socio-economic, gender and health services factors affecting diagnostic delay for tuberculosis patients in urban Zambia' by D. Needham, S. Foster, G. Tomlinson and P. Godfrey-Faussett, Tropical Medicine and International Health 6 (2001)

Funded by: Canadian Medical Research Council; Commonwealth Foundation; Lennox-Boyd Memorial Trust; GlaxoWellcome; UK Department for International Development; Beit Memorial Trust; European Community; World Health Organisation

id21 Research Highlight: 7 September 2001

Further Information:
Dale Needham
Box 266
Ilderton
Ontario
Canada N0M 2A0

Contact the contributor: dale.needham@utoronto.ca

London School of Hygiene and Tropical Medicine, UK

Peter Godfrey-Faussett
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0) 20 7612 7804
Fax: +44 (0) 20 7637 4314
Contact the contributor: Peter.Godfrey-Faussett@lshtm.ac.uk

Other related links:
See this issue of International Health Matters on TB.

Refer to the WHO programme on TB.

World TB Day is 24th April.

Stop TB also has many on-line resources.

The Medical Research Council of South Africa has information on TB research in the region.