Revue generale Les determinants du delai de diagnostic de la tuberculose dans les pays aux ressources limitees Determinants of tuberculosis diagnosis delay in limited resources countries

AbstractBackground. – Delayed diagnoses of pulmonary tuberculosis contribute to the spread of the epidemic.Methods. – This study aims to identify risk factors associated with patient delay (from symptoms onset to the first visit), health system delay(from the first visit to the tuberculosis treatment initiation) and total delay (sum of the patient and the health system delay) in low income and hightuberculosis burden countries. A systematic literature review has been performed using the keywords: ‘‘tuberculosis’’; ‘‘delay’’, care seeking’’;‘‘health care seeking behavior’’; ‘‘diagnosis’’ and ‘‘treatment’’. Only quantitative studies showing delays for pulmonary tuberculosis adult caseswere included in this review.Results. – Low income, gender, rural life, unemployment, ageing and misunderstanding the microbial cause of tuberculosis are associated withdelayed diagnoses. Systemic factors including low health care coverage, patient expenditures and entry into the health system by consulting atraditional healer or a non-skilled professional delay the beginning of tuberculosis treatment.Conclusion. – Delays can be used as indicators to evaluate tuberculosis control programs. Active case finding in the households of contagiouspatients can help to diminish diagnostic delays in low-income countries with high endemicity.# 2011 Elsevier Masson SAS. All rights reserved.