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Interdisciplinary Perspectives on Infectious Diseases
Volume 2010, Article ID 412624, 8 pages
Research Article

Reasons for Delay in Seeking Care for Tuberculosis, Republic of Armenia, 2006–2007

1Department of Epidemiology, Rollins University of Public Health, Emory University, Atlanta, GA 30307, USA
2Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
3Public Health Informatics and Technology Program Office, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
4Department of Tuberculosis, Yerevan State Medical University, Armenia
5National Institute of Health, Ministry of Health, Armenia
6Department of Epidemiology, National Institute of Health, Ministry of Health, Armenia
7Mission East, International Relief and Development Organization, Armenia

Received 26 August 2009; Revised 9 February 2010; Accepted 4 March 2010

Academic Editor: Joshua Metlay

Copyright © 2010 Dana Schneider et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. In Armenia, case reports of active TB increased from 590 to 1538 between 1990 and 2003. However, the TB case detection rate in Armenia in 2007 was only 51%, indicating that many cases go undetected or that suspected cases are not referred for confirmatory diagnosis. Understanding why Armenians do not seek or delay TB medical care is important to increase detection rates, improve treatment outcomes, and reduce ongoing transmission. Methods. Two hundred-forty patients hospitalized between August 2006 and September 2007 at two Armenian TB reference hospitals were interviewed about symptoms, when they sought medical attention after symptom onset, outcomes of their first medical visit, and when they began treatment after diagnosis. We used logistic regression modeling to identify reasons for delay in diagnosis. Results. Fatigue and weight loss were significantly associated with delay in seeking medical attention [ a O R = 2 . 4 7 (95% C I = 1 . 1 5 , 5.29); a O R = 2 . 9 9 (95% C I = 1 . 4 6 , 6.14), resp.], while having night sweats protected against delay [ a O R = 0 . 4 8 (95% C I = 0 . 2 4 , 0.96)]. Believing the illness to be something other than TB was also significantly associated with delay [ a O R = 2 . 6 3 (95% C I = 1 . 1 3 , 6.12)]. Almost 20% of the 240 TB patients were neither diagnosed at their first medical visit nor referred for further evaluation. Conclusions. This study showed that raising awareness of the signs and symptoms of TB among both the public and clinical communities is urgently needed.