Delay in tuberculosis diagnosis and treatment in Bissau, Guinea-Bissau

<b>Introduction:</b> Delay in tuberculosis diagnosis implies a delay in its treatment and perpetuation of the transmission chain. This delay may be due to the patient, but it may also be due to the health system. <b>Objectives:</b> This study aimed to identify factors associated with delayed diagnosis and initiation of tuberculosis treatment in a population of inpatients in an hospital in Bissau. <b>Material and Methods:</b> Questionnaire with demographic, clinical and socio-economic characteristics of inpatients in Raoul-Foullereau hospital, in December 2017. <b>Results:</b> We questioned 68 adult inpatients and 55.9%(n=38) were male with mean age of 33.7±1.3 years. 19.1% were illiterate. 52.9% were living in Bissau and the mean household was 9 people and 5.9% didn’t have a window in their home. Family income was lower than national minimum wage in 7.4% patients. Nearest health center was at a distance of 1-10 km for 47.1% patients and 66.2% had to walk there by foot. HIV was positive in 28.8% but Gene Xpert was only performed in 8.8%. Average time to look for a official health center after initial sympthoms was 27.8±5.8 days and 54.4% had at least 4 consultations before diagnosis. Longer patient delay to seek for a health care facility was associated with a distance superior to 10km (p=0.021), illiteracy (p=0.04) and income lower than the national minimum wage (p=0.035). HIV positive status was associated with a longer delay to initiate treatment (p=0.039). Delay for treatment initiation after first sympthoms was 131.5±15.2 days, essentially due to the health care system. <b>Conclusions:</b> There must be a greater focus on health systems, wich, as we see, in this population was the main cause of delay in starting treatment.