Patterns of delays amongst pulmonary tuberculosis patients in Lagos, Nigeria

Background: Pulmonary tuberculosis continues to increase due to late patient presentation. The study was conducted at a chest clinic of a general hospital in Lagos, Nigeria, to investigate patterns of delays before treatment amongst tuberculosis patients. Methods: Longitudinal recruitment using a health worker administered protocol to determine time interval from onset of symptoms to initiation of treatment. Presentation to a health facility after 30 days of the onset of symptoms was classified as patient delay. Doctor delay was when patients stayed for more than 15 days with the referring doctor. Results: One hundred and forty-one patients were recruited. The mean age was 29.5 +/- 11.0 years, 89 (63%) were males and 52 (37%) were females. One hundred and sixteen (82%) had positive smears. One hundred and seventeen (83%) delayed their seeking help from health facilities longer than one month after the onset of symptoms. The median patient delay was eight weeks; median doctor delay was one week, median treatment delay was one week and the median total delay was 10 weeks. Doctor delay was observed in 19 (13%) patients. Patient delay was the most frequent type of delay observed and was the major contributor to the overall total delay. Patient delay was not significantly associated with patients' socio-demographic characteristics such as age, gender and educational level. Conclusion: Majority of TB patients at this centre did not present early to health facilities and continue to serve as reservoirs of infection. Patient education on the disease may help reduce delays in starting treatment.