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Int J Tuberc Lung Dis. 2010 Nov;14(11):1403-10.

Delay in diagnosis of pulmonary tuberculosis at a primary health clinic in Vitoria, Brazil.

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Nucleo de Doenças Infecciosas, Universidade Federal do Espirito Santo, Vitoria, Espirito Santo, Brazil.



Primary health clinics in Vitoria, Espirito Santo, Brazil.


To identify risk factors associated with patient and health care delays among patients seeking care at primary health clinics.


A prospective study among tuberculosis (TB) patients diagnosed in Vitoria between 1 January 2003 and 30 December 2007. A questionnaire ascertained the date of onset and duration of TB symptoms and medical records were reviewed. Between-group distributions of delay were compared and multivariate logistic regression was performed.


Of 304 patients, 296 (97%) reported at least one TB symptom presenting for the first time to a qualified health service; 244 (80%) reported cough > 3 weeks. Median health care delay was 30 days (range 5-68), and median total delay was 110 days (range 26-784). Multivariate analysis revealed any cough (OR(adj) 7.35, 95%CI 2.40-22.5) and weight at TB diagnosis < 60 kg (OR(adj) 5.92, 95%CI 1.83-19.1) to be associated with patient delay of ≥ 30 days. Factors increasing risk of prolonged delay (≥ 90 days) were age ≥ 30 years (OR(adj) 1.93, 95%CI 1.09-3.43) and chest pain (OR(adj) 2.42, 95%CI 1.29-4.53).


Improving health care workers' education regarding TB symptoms and implementing active case finding in targeted populations may reduce delays.

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