Long delays and missed opportunities in diagnosing smear-positive XXXX in Kampala, Uganda: a cross-sectional study.

@entity1 @entity645 @entity1906 @entity378 @entity1907
BACKGROUND: Early detection and treatment of @entity378 cases are the hallmark of successful @entity378 control. We conducted a cross-sectional study at public primary health facilities in Kampala city, Uganda to quantify diagnostic delay among @entity1907 ( @entity1907 ) @entity1 , assess associated factors, and describe trajectories of @entity1 ' health care seeking. METHODOLOGY/PRINCIPAL FINDINGS: Semi-structured interviews with new smear-positive @entity1907 @entity1 (>=  15 years) registered for treatment. Between April 2007 and April 2008, 253 @entity1 were studied. The median total delay was 8 weeks (IQR 4-12), median @entity1 delay was 4 weeks (inter-quartile range [IQR] 1-8) and median health service delay was 4 weeks (IQR 2-8). Long total delay (>14 weeks) was observed for 61/253 (24.1%) of @entity1 , long health service delay (>6 weeks) for 71/242 (29.3%) and long @entity1 delay (>8 weeks) for 47/242 (19.4%). @entity1 who knew that @entity1906 was curable were less likely to have long total delay (adjusted Odds Ratio [aOR] 0.28; 95%CI 0.11-0.73) and long @entity1 delay (aOR 0.36; 95%CI 0.13-0.97). Being female (aOR 1.98; 95%CI 1.06-3.71), staying for more than 5 years at current residence (aOR 2.24 95%CI 1.18-4.27) and having been tested for @entity645 before (aOR 3.72; 95%CI 1.42-9.75) was associated with long health service delay. Health service delay contributed 50% of the total delay. Ninety-one percent (231) of @entity1 had visited one or more health care providers before they were diagnosed, for an average (median) of 4 visits (range 1-30). All but four @entity1 had systemic symptoms by the time the diagnosis of @entity1906 was made. CONCLUSIONS/SIGNIFICANCE: Diagnostic delay among @entity378 @entity1 in Kampala is common and long. This reflects @entity1 waiting too long before seeking care and health services waiting until systemic symptoms are present before examining sputum smears; this results in missed opportunities for diagnosis.
