Health care seeking behaviour for tuberculosis symptoms in Kiev City, Ukraine.

SETTING: Tuberculosis (TB) doctors in Kiev City have the impression that TB patients often present with advanced TB disease, and the mortality rate among TB patients is high. Delay in seeking health care may explain these observations. OBJECTIVE: To assess the magnitude of patient delay and evaluate risk factors for delay. DESIGN: We included 190 newly diagnosed pulmonary TB patients. For each patient, information was gathered through interviews and from the medical records. RESULTS: The median time between the start of symptoms and the first visit to a health care provider (patient delay) was 30.0 days. Individuals reporting unemployment, cough or loss of weight before seeking health care had a longer patient delay. The same applies to individuals with the risk factors homelessness, joblessness or alcohol abuse. The main reasons for delay among those who presented late were 'thought symptoms would go away' and 'symptoms not considered serious'. CONCLUSION: For most TB patients, the time between start of symptoms and first health care seeking action was acceptable. Long patient delay was reported by individuals who were homeless, jobless or abused alcohol. Specific activities will have most effect if they are targeted at these vulnerable and difficult to reach groups.