Factors influencing delayed Diagnosis of Tuberculosis in Mukono District, Uganda.

Abstract

Setting This study was carried out in Mukono District situated in the South East of Uganda. TB cases present late for care and the factor influencing these delays were not known in district. Objectives The study aimed at determining the average duration of delays and identifying the factors influencing these delays. Methodology The study was carried out in 11 purposively selected TB diagnostic and treatment units. A proportionate and systematically indentified number of patients (384) were selected from each unit and interview using a pre-tested semi-structured questionnaire. Additional information was also obtained from eight FDGs and 10Klls. Results The geometric mean of the total delay was found to be 107.9 days (median 120 days), with a patient’s delay of 45.15 days (median 60 days) and a health facility’s delay of 24 days( median 23 days). Female were 6 times more likely to have a longer total delay (p=0.013), and 5 times more likely to have a longer patient’s delay than Males (p=0.021). Knowledge of stigmatizing cultural beliefs, perceiving the symptoms initially as mild and perceiving the units as only useful some of the times were associated with a longer total and patient’s delay(p=<0.01). The private units were 2 times more likely to have a longer health facility’s delay than government units (p=0.019). Most patients (67.5%) were aware of the cause, mode of spread and symptoms of TB and most (232, 60.4%) had a positive attitude towards it, whereas the general community had a low level of awareness with a negative attitude, and a lot of stigma attached to tuberculosis. Conclusions The delays were too long. Being a female, perceiving the sickness as mild at its onset, knowledge of stigmatizing cultural beliefs and negative perceptions of the quality of care promoted the late seeking care. Private units took longer to diagnose tuberculosis compared to government units. Patients had adequate knowledge and a positive attitude towards tuberculosis. The general community, however, had low awareness and a negative attitude towards tuberculosis. Recommendations Health education should be emphasized. Health care delivery in existing health units be improved by better management of resources. Continuing medical education should be emphasized with the involvement of workers in private units. Improvement of the economic status of women is a necessity.