Health care‐seeking behaviour and diagnostic delays for Human African Trypanosomiasis in the Democratic Republic of the Congo

Summary Objective About half of the patients with Human African trypanosomiasis (HAT) reported in the Democratic Republic of the Congo (DRC) are currently detected by fixed health facilities and not by mobile teams. Given the recent policy to integrate HAT control into general health services, we studied health seeking behaviour in these spontaneously presenting patients. Methods We took a random sample from all patients diagnosed with a first‐time HAT episode through passive case finding between 1 October 2008 and 30 September 2009 in the two most endemic provinces of the DRC. Patients were approached at their homes for a structured interview. We documented patient delay (i.e. time between onset of symptoms and contacting a health centre) and health system delay (i.e. time between first contact and correct diagnosis of HAT). Results Median patient delay was 4 months (IQR 1–10 months, n = 66); median health system delay was 3 months (IQR 0.5–11 months). Those first presenting to public health centres had a median systems delay of 7 months (IQR 2–14 months, n = 23). On median, patients were diagnosed upon the forth visit to a health facility (IQR 3rd–7th visit). Conclusions Substantial patient as well as health system delays are incurred in HAT cases detected passively. Public health centres are performing poorly in the diagnostic work‐up for HAT, mainly because HAT is a relatively rare disease with few and non‐specific early symptoms. Integration of HAT diagnosis and treatment into general health services requires strong technical support and well‐organized supervision and referral mechanisms. Objectif: Près de la moitié des patients souffrant de la trypanosomiase humaine africaine (THA) rapportés en République Démocratique du Congo (RDC) sont actuellement détectés dans des établissements de santé fixes et non par des équipes mobiles. Compte tenu de la récente politique d’intégrer la lutte contre la THA dans les services de santé en général, nous avons étudié le comportement de recours à la santé chez les patients se présentant spontanément. Méthodes: Nous avons prélevé un échantillon aléatoire de tous les patients diagnostiqués avec un premier épisode de THA dans la recherche passive des cas entre le 1er octobre 2008 et le 30 septembre 2009 dans les deux provinces les plus endémiques de la RDC. Les patients ont été contactés à domicile pour un sondage structuré. Nous avons enregistré le retard du patient (i.e. le temps entre l’apparition des symptôm