Pulmonary tuberculosis: diagnostic delay in Ghanaian adults

Setting: Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana, West Africa.Objective: To determine the factors affecting the delay from the onset of symptoms of pulmonary tuberculosis until the initiation of treatment.Design: A retrospective questionnaire survey of 100 adults with newly diagnosed smear-positive pulmonary tuberculosis.Results: The median total delay in diagnosis was 4 months (mean = 7.7), and total delay exceeded 6 months in 44% of patients. Total delay was strongly associated with rural residence (P = 0.001). The median doctor delay from the first consultation until diagnosis was double the median patient delay in initial presentation (8 weeks versus 4 weeks). Doctor delay was significantly increased in females, rural patients, and among those needing hospital admission. Increased doctor delay was strongly correlated with rates of failure to perform sputum microscopy (r = 0.99), low rates of diagnosis, and was seen particularly among private practitioners and rural government institutions.Conclusion: Delays in the diagnosis of pulmonary tuberculosis are prolonged in Kumasi, Ghana, with a frequently lengthy doctor delay. The new National Tuberculosis Programme is decentralising the diagnosis and management of tuberculosis, with the introduction of widely available sputum microscopy and rigorous training of health personnel. This should help to reduce doctor delay and thereby improve tuberculosis control.