Pulmonary tuberculosis in Kweneng District, Botswana: delays in diagnosis in 212 smear-positive patients.

SETTING: Health facilities in Kweneng District, Botswana. OBJECTIVES: To describe and analyse causes of delays in the diagnosis of smear-positive pulmonary tuberculosis. DESIGN: Cross-sectional descriptive study based on data from patient records and interviews of 212 cases. RESULTS: Median total delay was 12 weeks (mean 17.3), median patient's delay was three weeks (mean 5.1), median health services' delay was five weeks (mean 12.2). An inverse relationship was found between patient's delay and health services' delay. Treatment was started on the basis of positive acid-fast bacilli in 165 patients (78%), and chest X-ray findings in 47 (22%). Delayed sputum examination despite prolonged productive cough was common, and 31 patients (15%) had one or more negative initial investigations. Significant risk factors for delay were: first visit to a health post, and visiting a traditional or faith healer before start of treatment (total delay and health services' delay); treatment of a sexually transmitted disease in the last three years (total delay); staying in a village without a hospital, self-rated health being held as poor or very poor, and being married (health services' delay); and self-rated health being fair or good (patient's delay). CONCLUSIONS: Sputum must be examined in all patients with prolonged productive cough, and negative investigations should be repeated. Patients should be told to return if symptoms persist. Dialogue between modern health workers and traditional healers should be encouraged.