Knowledge of disease and treatment among tuberculosis patients in Mwanza, Tanzania.

SETTING: A health care facility based study in a rural and urban setting in Mwanza region, Tanzania. OBJECTIVE: To determine patients' general knowledge of tuberculosis (TB) and the management of the disease. DESIGN: From 7 May to 7 July 1998, 296 pulmonary tuberculosis patients were consecutively interviewed. The majority of the respondents (89%) were outpatients. Questions were based on Tanzanian National Tuberculosis Programme (NTP) treatment guidelines for teaching tuberculosis patients. RESULTS: When correct answers to five out of seven questions asked was regarded as satisfactory knowledge, only 30% of the study population had satisfactory knowledge of disease and treatment. Persons with information on TB prior to diagnosis and those with higher education were more likely to have satisfactory knowledge (OR 9.23 and 19.93; 95%CI 2.77-31.08 and 5.74-69.19, respectively). There was a negative correlation between the level of knowledge and patients' age (-r = 0.181, P = 0.01). Knowledge was not significantly affected by sex or area of residence. The two most important sources of information about TB were health workers and former TB patients. CONCLUSIONS: Using NTP guidelines as reference, a substantial number of patients interviewed in health facilities in the study period had an unsatisfactory knowledge of TB disease and its management. The study did identify factors associated with satisfactory knowledge that could assist in designing health education intervention strategies.

Delay in tuberculosis case-finding and treatment in Mwanza, Tanzania.

SETTING: Health facilities in Mwanza region, Tanzania. OBJECTIVE: To determine factors responsible for delay from onset of symptoms of pulmonary tuberculosis to initiation of treatment. DESIGN: A cross-sectional descriptive study of 296 smear-positive tuberculosis patients. Emphasis was given to periods between 1) onset of symptoms and first consultation to a health facility, and 2) reporting to a health facility and initiation of treatment. RESULTS: Mean total delay was 185 days (median 136), with nearly 90% of this being patient's delay. The mean health system delay was 23 days (median 15), with longer delays in rural health facilities. The mean patient's delay was 162 days (median 120). This delay was significantly longer in rural areas, for patients with lower level of education, for those who first visited a traditional healer, and for patients who had no information on tuberculosis prior to diagnosis. Only 15% of the patients reported to a health facility within 30 days of onset of symptoms. CONCLUSION: There are significant delays in case-finding in Mwanza, Tanzania, with prolonged patient's delay. Facilitation of utilisation of health services, raising awareness of the disease and incorporation of private practice into tuberculosis control could help to reduce these delays.