Abstract:
Tuberculosis remains as a public health problem since ancient times. Delay in diagnosis of
pulmonary tuberculosis can bring harmful consequences not only to the patients but also to
the community. This study aims to identify the factors contributing to the delay in diagnosis
since care seeking in the district of Anuradhapura. This is a descriptive study conducted at
the main chest clinic and branch chest clinics located in Anurildhapura district. Study
population composed of non-institutionalized pulmonary TB patients aged more than is
years old. During the study period, it \\as possible to recruit 134 eligible subjects. An
interviewer administered questionnaire \Vas used for data collection. The information
obtained \\as cross checked \\ith available medical records. Mean age of the patients studied
was 46-.4 years (SD = 1-.+ 0) ;lnd i.lhl)ut 60 percent of patients interviewed were in the
economically active age group (ie 26 tel 55 years) Out of the patients studied 79 percent
were males, 87 percent were Sinhalese, and 86 percent resided outside city limits. About
43 percent of patients had only primary education and 86 percent were unemployed or
unskilled. Median health care provider delay for pulmonary TB patients studied was 36 days
(mean 52 days). Out of the patients studied, 84 percent of patients (n ~c 112) experienced
longer provider delay ( 10 days). Age (chi-squire =: 3.,14, df= 2, p 0.05), sex (chi-square =
1.19, df=: I, p 0.05 and OR =: 2.0, 95 percent CI: 0.7, 5.6), ethnicity (chi-square = 0.51, df =
1, p 0.05 and OR =: 0.6, 95 percent CI: 0.3, 1.8), occupation (chi-square =: 0.22, df = I, P
0.05), mode of referral (Chi-squ:ne =: 0.09 J, df =: 1, p 0.05), sputum negativity (Chi-square
= 2.794, df =: I, P 00.5) '",,: smoking (Chi-square = 0.29, df = 2, r 005) and alcohol
addiction (Chi-square =: 0.39, df =: 2, p 0.05) did not significantly associate with longer
health care provider delay. There were also no statistically significant associations between
provider delay and the type of symptoms present during first visit such as cough (Chi-square
= 0.1 17, df = 1, p 0.05 and OR = 0.8), haemoptysis (Chi-square = 2.642. df= 1, p 005 and
OR = 0.46) and fever (Chi-square = 0.704, df = I, p 0.05 and OR = 0.65). The main
limitation of this study is the failure of recruiting adequate number of eligible subjects. I
!however this was beyond control considering the number of patients registered in the study
area over the years. Continuous medical education for health care providers. improvement
of diagnostic facilities and establishment of a referral mechanism were S0rne of the
strategies recommended to reduce the provider delay. Age (chi-squire =: 3.,14, df= 2, p
0.05), sex (chi-square = 1.19, df=: I, p 0.05 and OR =: 2.0, 95 percent CI: 0.7, 5.6), ethnicity
(chi-square = 0.51, df = 1, p 0.05 and OR =: 0.6, 95 percent CI: 0.3, 1.8), occupation (chisquare =: 0.22, df = I, P 0.05), mode of referral (Chi-squ:ne =: 0.09 J, df =: 1, p 0.05),
sputum negativity (Chi-square = 2.794, df =: I, P 00.5) '",,: smoking (Chi-square = 0.29, df
= 2, r 005) and alcohol addiction (Chi-square =: 0.39, df =: 2, p 0.05) did not significantly
associate with longer health care provider delay. There were also no statistically significant
associations between provider delay and the type of symptoms present during first visit such
as cough (Chi-square = 0.1 17, df = 1, p 0.05 and OR = 0.8), haemoptysis (Chi-square =
2.642. df= 1, p 005 and OR = 0.46) and fever (Chi-square = 0.704, df = I, p 0.05 and OR =
0.65). The main limitation of this study is the failure of recruiting adequate number of
eligible subjects. I !however this was beyond control considering the number of patients
registered in the study area over the years. Continuous medical education for health care
providers. improvement of diagnostic facilities and establishment of a referral mechanism
were S0rne of the strategies recommended to reduce the provider delay