Demora en el diagnóstico de tuberculosis pulmonar en una región de Colombia

Delayed diagnosis of pulmonary tuberculosis in a particular part of Colombia

Objetivo. Determinar la demora en el diagnóstico de tuberculosis y los factores asociados a la misma.
Métodos. Estudio de Corte transversal, mediante entrevista a tuberculosos adultos, se obtuvieron variables sociodemográficas y tiempo desde el inicio de síntomas al diagnóstico. Se definió como demora el tiempo mayor a la mediana del intervalo, así: demora del paciente, entre inicio de síntomas y primera consulta; demora de servicios de salud, desde la primera consulta hasta el diagnóstico; y, demora total del inicio de síntomas al diagnóstico. Se calcularon OR para establecer asociación entre demora y varios factores mediante modelos de regresión logística.
Resultados. Se estudiaron 216 participantes, 61 % hombres y con edad promedio de 43 años. La demora del paciente fue mayor a 30 días y estuvo asociada a desempleo (OR 2.56, IC95 % 1,28-4,76) y no tener seguridad social (OR 2,32, IC95% 1,20-4,50). La demora de servicios de salud fue mayor a 60 días y estuvo asociada al régimen contributivo de seguridad social (OR 1,91, IC95 % 1,07-3,44) y al desplazamiento (OR 0,20, IC95 % 0,06-0,67). La demora total fue de 120 días asociada a no tener seguridad social (OR 3,54, IC95 % 2,25-10,8).
Conclusión. La mediana del tiempo total entre el inicio de síntomas y el diagnóstico de tuberculosis fue de 120 días. Otros estudios reportan entre 42 y 119 días. Se recomienda agilizar el diagnóstico de tuberculosis pulmonar para evitar el contagio a otras personas. Se requieren reforzar el compromiso de los servicios de salud.

Objective. The present study was aimed at establishing delay in diagnosing tuberculosis and associated factors.
Methods. This was a cross-sectional study. Adults from the city of Bucaramanga proving smear-positive for tuberculosis were interviewed for establishing demographic and social variables; the onset of symptoms, the date of their first visit to a doctor and time of diagnosis were established. Delay was defined as being any time longer than the mathematical average interval for such attention. Patient delay was taken as being from the onset of symptoms to the first visit to a doctor. Health service delay consisted of the time taken from first visit to diagnosis. Total delay was regarded as being from the onset of symptoms until diagnosis. Odds ratios (OR) were calculated and association between delay and risk factors was evaluated by using logistical regression.
Results. Two hundred and sixteen patients were interviewed; 131 (61 %) were males and mean age was 43. Patient delay was longer than 30 days; it was associated with unemployment (2.56 OR; 1.28-4.76 95 %CI) and the absence of social security (2.32 OR; 1.20-4.50 95 % CI). Health service delay was greater than 60 days and was associated with the contributive social security regime (1.91 OR; 1.07-3.44 95 % CI) and displacement (0.20 OR; 0.06-0.67 95 % CI). Total delay was greater than 120 days and was associated with patients lacking social security (3.54 OR; 2.25-10.8 95 % CI).
Conclusion. Average delay time for diagnosing pulmonary tuberculosis was 120 days. This was higher than in other studies which have reported delay as being 42 to 119 days. We recommend expediting the diagnosis of pulmonary tuberculosis so that other people do not become infected and improving health service commitment.