Study On Diagnosis Delay And Its Factors Among Patients With Smear-positive Pulmonary Tuberculosis In Wuhan

Objective:1. To analysis the visit medical institution and the number of medical visits for smear-positive pulmonary tuberculosis in Wuhan city;2. To analysis the knowledge, attitude, behavior of smear positive tuberculosis patients in Wuhan city;3. To evaluate the first diagnosis delay, patients'delay, health system delay and diagnosis delay for smear-positive tuberculosis patients in Wuhan;4. To analyze factors associated with various delay among patients with pulmonary tuberculosis, and to provide some reference advices for improving the detection rate.Method:Smear-positive pulmonary tuberculosis patients hospitalized in Wuhan TB center during October to December 2009 were investigated. Data were entered into an Epidata (version 3.1) database and checked for errors by trained workers. Data analysis was done using the SPSS statistical software program version 15.0 (Statistical Product and Service Solutions 15.0).Results:1. The 229 patients with smear-positive pulmonary tuberculosis were investigated. 161 of them were male, and 68 of them were female. The average age for patients was 41.32±17.597 years, ranged 13 to 79 years old. Patients with below three diagnosis, the first diagnosis, 36 patients (15.7%) received treatment in professional TB institutions (district and city TB institutions). And 26 cases (11.4%) still not went to professional tuberculosis institutions for treatment after three diagnosis, and the highest seeking number was 7 times. First diagnosis institution for retreatment cases and new cases, 36 cases who had first diagnosis for professional TB institutions, only 12(7.7%) were new cases and 24(32.8%) were retreatment cases.2. Knowledge scores in the retreatment patients was higher than new case, and the difference was statistically significant (t = 5.532, P <0.01); social support and self-esteem was negatively correlated with statistical significance (P <0.01).3. The median of 224 cases'first diagnosis delay and patients'delay is 8 days and 14 days respectively. 145(63.3%) cases'patients'delay is equal to first diagnosis delay, with a median of 10 days; and 79(34.5%) cases'patients'delay was much larger than first diagnosis delay, with a median of 38 days and 7 days respectively.4. The male (OR = 2.134, 95%CI: 1.115~4.083), middle school or below education (OR = 1.879, 95%CI:1.048~3.368), no hemoptysis (OR = 2.194, 95%CI: 1.056~4.559) and lower TB-related knowledge (OR = 4.060, 95%CI: 2.232~7.385) were risk factors for the first diagnosis delay; Middle school or below education (OR = 2.421, 95%CI: 1.220~4.804), untreated patients (OR = 2.126, 95%CI: 1.030~4.387), lower TB-related knowledge (OR = 7.292, 95%CI: 3.659~14.532), severe self-esteem and self-stigma (OR = 2.132, 95%CI: 1.092~4.167), under district medical units for first diagnosed(OR=3.249, 95%CI: 1.606~6.569) were risk factors for patients'delay. Under district medical units for first diagnosed (OR = 2.938, 95%CI: 1.339~6.446) was risk factors,and visits number≤1(OR=0.056, 95%CI: 0.025~0.126)was the protective factor for health system delay. Lower TB-related knowledge (OR=3.036, 95%CI: 1.654~5.572), high level of stigma(OR=2.012, 95%CI: 1.103~3.676) were the risk factors, and visits number≤1(OR=0.216, 95%CI: 0.117~0.396) was the protective factor for diagnosis delay. Conclusions:1. It was necessary to enhance knowledge of tuberculosis in the crowd, especially for those with low educational level, to strengthen the recognition of disease knowledge, improve their attitude and self-awareness.2. To improve public awareness, and avoid the discrimination and isolation to TB patients; to eliminate patient self-shame, and improve the attendance rate for suspects effectively.3. We should strengthen enhance awareness of medical staff in the community and improve the ability of early diagnosis of TB, finally improve the detection rate of TB through the utilization of general hospital or community health service centers.4. The repeating visits to the same level of medical unit should be avoided, and improve the utilization of TB prevention and control institutions.5. To improve the medical ethics of medical staff, and change their attitude, not to keep patients for benefits.