Determinants of health system diagnostic delay of pulmonary tuberculosis in Gurage and Siltie zones, South Ethiopia: a cross-sectional study.

Background: Unrecognised transmission of tuberculosis is a main contributor of high epidemic of tuberculosis in low-income countries. Studies done in Ethiopia showed that delay in tuberculosis diagnosis and treatment is one of the major challenges to tuberculosis control programmes in the country. This study assessed factors which predict health system diagnostic delay of new pulmonary tuberculosis in Gurage and Siltie zones, South Ethiopia.

Methods: A health facility-based cross-sectional study was conducted among 204 adult patients with new pulmonary tuberculosis in Gurage and Siltie zones. Consecutive sampling technique was used to recruit participants. Data were collected by using a structured and pretested Amharic questionnaire. Data were entered into Epi-info V.7, processed and analysed by SPSS V.20. Health system diagnostic delay was dichotomised as either long or acceptable delay using median delay.

Results: Median (IQR) patient and health system diagnostic delays are almost equal which are 20 (10-34.5) and 20.5 (8.2-56.2) days, respectively. Results from logistic regression show that presence of long patient delays (adjusted OR (AOR)=2.85, 95% CI: 1.44 to 5.62; p=0.003) in seeking care, presence of sputum smear examination (AOR=0.37, 95% CI: 0.19 to 0.75; p=0.005) at the first visit to a health facility and multiple heath facility visit before diagnosis of tuberculosis (AOR=4.95, 95% CI: 1.98 to 12.40; p=0.001) were factors significantly associated with long health system diagnostic delay.

Conclusions: Long patient delay and multiple health facility visits are positively associated with long health system diagnostic delay; whereas sputum smear examination at the first contact with a health facility is negatively associated with long health system tuberculosis diagnostic delay.