BMC Public Health 2009, 9:53 http://www.biomedcentral.com/1471-2458/9/53 Table 4: Health access and health care seeking characteristics of pulmonary tuberculosis patients (n = 924) and patient delay at first consultation in Ethiopia during 2005–2006. Variables Treatment sought prior to first visit in public health facilities: No prior treatment Holy water Traditional healers Private practitioners Private drug stores/pharmacies The number of alternative treatments sought prior to the first consultation Zero One Two Three Four times Type of health facilities visited for the first time since onset of illness: Hospitals Health centres Clinics One way walking time to first visited health facility: ≤ 1 hour (median) > 1 hour Decision to visit the first public health facilities was made by: Patients themselves Private practitioners Family members Others1 1 Volunteer community health workers, neighbours and friends. and failure of health systems to provide accessible and acceptable health care: others suggest the difference is due to differences in biological susceptibility between men and women [19]. Further investigations are needed in this area. In line with previous reports [5,6], illiteracy and rural res- idence were significantly associated with prolonged patient delay. Neither low monthly income nor depend- ence on government food aid programme was an inde- pendent predictor of prolonged patient delay. The lack of association of low income with prolonged delay could be due to its interaction with patients' area of residence and other economic parameters used in this study. Based on the parameters used to measure patients' economic status, most (66%) were destitute (earning less than 1 United States dollar per day) [20] and 25% were on government food aid programme targeted to support households with no means of livelihood. In Ethiopia, patients are entitled to free medical care in public health facilities when they have been ascertained unable to pay. Of our respondents, 239 (26%) were entitled to free medical care while 345 (38%) failed to qualify and 324 (36%) did not ask for such services. This shows that more than a third of Patient delay ≥ 30 days n (%) < 30 days n (%) COR (95% CI) P-value 211(43) 166(74) 18(61) 64(55) 34(57) 212(43) 199(63) 65(71) 14(82) 3 297(50) 131(57) 65(65) 226(48) 267(59) 308(52) 23(55) 126(60) 36(46) 285(57) 57(26) 10(39) 53(45) 26(43) 285(57) 117(37) 26(29) 3(18) - 296(50) 100(43) 35(35) 243(52) 188(41) 286(48) 19(45) 84(40) 42(54) 1 3.9(2.8, 5.5) 2.2(0.9, 4.8) 1.6(1.1, 2.4) 1.8(1.1, 3) 1 2.8(1.7, 3) 3.4(2, 5.4) 6.3(1.7, 77) - 1 1.3(0.9, 1.8) 1.9(1.2, 2.8) 1 1.5(1.2, 1.9) 1 1.1(0.6, 2.1) 1.4(1.01,1.9 0.8(0.5,1.5) 0001 0.06 0.02 0.04 0001 0.002 0.004 - 0.08 0.006 0.001 0.7 0.04 0.3 patients were unable to pay even the minimal medical consultation fee seen in Ethiopia (US$ 0.2 for the first consultation). These findings indicate that rural residence could be an appropriate proxy measure of poverty in Ethi- opia and the high level of rural poverty may preclude equal proportions of rural and urban patients [AOR = 1.43; 95%CI (1.1 to 1.9); p = 0.02] from seeking timely care in public health facilities. Being a rural resident has been reported to be a strong marker of poverty and an independent predictor of patient-delayed first consulta- tion in other studies in Ethiopia [8]. Health seeking behaviour The use of an informal treatment/provider was a strong predictor of prolonged patient delay in this study. Endog- enous traditional medicine is widely practiced in Ethiopia [21]. Patient delayed consultation for modern health care has been associated with the use of traditional medicine in Ethiopia [4,6,8] and in sub-Saharan Africa [16,22]. However, the relative contribution of such alternative sources of treatment to patient delay has never been thor- oughly investigated. Our findings indicate that 46% of patients had sought modern care after informal treatment failed. In the order of their contribution to patient delay, Page 6 of 10 (page number not for citation purposes)