Treatment delay of smear-positive pulmonary tuberculosis in Chad: a cross-sectional study

OBJECTIVES Delay in diagnosis and treatment of smear positive pulmonary tuberculosis has been strongly associated with adverse clinical outcomes and the spread of tuberculosis. Improving case finding strategies is of paramount importance, in order to reduce tuberculosis burden in high endemic regions. Many studies have been published on delay in the diagnosis and treatment of tuberculosis, but none has been performed in Chad, one of the lowest income countries in Africa. The primary aim of this study was to assess treatment delay in patients affected by smear-positive pulmonary tuberculosis in Chad. The secondary aim was to identify factors associated with treatment delay. METHODS This is a cross-sectional study of 58 adult patients treated for bacillary pulmonary tuberculosis in an urban hospital in N’Djamena, Chad. Data were collected retrospectively for a period of 1 year, since April 2011 to April 2012. Delay was classified as follow: Patient treatment delay (PTD); Health system treatment delay (HSTD); Total treatment delay (TTD). PTD was defined as the time from symptoms onset to first patient’s access to health care facilities. HSTD was defined as time from the first contact with a health care facility to the beginning of a complete anti-TB therapy. TTD was defined as the sum of PTD and HSTD. Data was analysed using the Mann-Whitney nonparametric statistical test for independent variables. The level of statistical significance was set at 5% (p<0.05). RESULTS Mean PTD was 45 days (range 0-176), mean HSTD was 17 days (0-270) and mean TTD was 68 days (5-270). These results were consistent with the data coming from previous publications concerning other Sub-Saharan Countries. The most frequent onset symptom was cough (83%). 26% of patients were coinfected with HIV. Tuberculosis was a new diagnosis in 83% of the cases, whereas the remaining 17% was considered as treatment failures or relapses. Subjects older than 30 years were significantly at higher risk of prolonged PTD (p<0.05). CONCLUSION There is a substantial delay between symptom onset and the commencement of treatment in patients with bacillary pulmonary tuberculosis in Chad, particularly in patient older than 30 years. More efficacious socio-sanitarian strategies are essential to reduce the treatment delay and, as a consequence, the transmission of tuberculosis in high endemic settings.