BMC Public Health 2009, 9:53 http://www.biomedcentral.com/1471-2458/9/53 revealing the disease to others). Patients' potential health access in terms of walking time to the nearest health facil- ity was assessed in order to determine their pattern of con- sultation at public health facilities. Trained nurses collected blood samples for HIV testing, and took weight and height measurements for assessing their nutritional status at presentation. Laboratory technicians at diagnos- tic centres carried out anonymous HIV test (Determine® HIV-1/2, Abbott Laboratories Limited, Illinois, USA). Body Mass Index (BMI) was computed to determine the nutritional status of patients. Using the World Health Organization standard classification, patients were cate- gorised as normal (BMI 18.5 to 24.99), moderate (BMI 17.5 to 18.49) and severely undernourished (BMI ≤ 17.5) [12]. In each district, patient records were crosschecked by two physicians to ascertain the accuracy of TB diagnosis. Generally, consultation is considered to be delayed if the first visit takes place more than three weeks after onset of symptoms [13]. However, in this study, to maintain com- parability of findings with other studies [4,5,8] a patient delay between onset of constitutional symptoms and first consultation at a public health facility of ≥ 30 days was used as a cut off point. This is referred to subsequently as 'prolonged patient delay'. Data entry and analysis was conducted with SPSS version 14 (SPSS, Inc., Chicago, USA). The percentage of patients who delayed seeking treatment and the median delays were calculated, and crude odds ratios and 95% confi- dence intervals were used to measure association between patients' demographic, economic, health status, percep- tion and level of TB awareness and prolonged patient delay. Multivariate logistic regression analysis was used to estimate the independent effects (Adjusted odds ration, 95% confidence intervals) of each factor on prolonged patient delay. Variables with P-value ≤ 0.2 were entered into multivariate logistic regression models (stepwise) and allowing interaction for confounding effect between potential risk factors. Results A total of 924 newly diagnosed PTB patients were prospec- tively enrolled from 21 diagnostic centres (10 hospitals and 11 health centres). Of these, 537 (58%) were sputum smear positive and 387 (42%) were sputum smear nega- tive pulmonary cases. The median age was 34 years and 509 of the patients (55%) were above 29 years of age. Of the total of 924 patients, 413 (45%) were female, 576 (52%) were married, 451 (49%) were rural residents, 359 (39%) depended on farming for a livelihood and 430 (47%) were illiterate. Patients' median family size and the number of living rooms were 3 and 1 respectively. Table 1 summarises patients' access to health care and health seeking behaviour. A total of 496 patients (54%) had not sought informal care for their symptoms between the onset of their illness and their first consultation at a public health facility, while 428 (46%) had sought care from at least one informal provider: 223 (24%) had been treated with holy water, 26 (3%) by traditional healers, 117 (13%) by private practitioners and 60 (6.5%) in pri- vate drug stores. 111 patients (12%) reported visiting at least two different informal providers prior to the first visit to a public health facility. The majority of patients (593 or 64%) made their first consultation at a district hospital, 231 (25%) attended a health centre and 100 (11%) a clinic. The median one way walking time from patient's residence to a public health facility was 40 minutes (with mean 68 minutes). Most patients (64%) decided to visit health facilities by themselves. Thirty-six percent of the patients visited a public health facility because they were advised to by members of their family, private practition- ers or volunteer community health workers. Forty three percent of patients were accompanied by at least one per- son (with range 1 to 11 people) when they arrived at the public health facility. The median patient delay among those who had used informal treatment was 31 days (Table 2). Patients with no prior history of informal treatment had the lowest patient delay (median = 15 days). The longest patient delay (median = 90 days) recorded was among patients who had been treated with holy water. The overall total median and mean patient delays were 30 and 60 days respectively. Of the total patients, 53%; 95% CI (50%, 56%) had delayed consultation for 30 days and longer. Patient delay was longer than 90 days in 15% of cases. Patient delay among women was 54%; 95% CI (54%, 58%) and men 51%; 95% CI (47%, 55%). Univariate analyses of risk factors for prolonged delay (first consultation after ≥ 30 days of onset of symptoms) are shown in Tables 3 to 5. Prolonged patient delay was significantly associated with literacy, rural residence, type of TB disease, occupation, nutritional status and whether patients were on government food aid programme. No significant association was found between prolonged patient delay and sex, age, marital status, HIV status and monthly income (Table 3). There was an association between prolonged patient delay and use of informal treatment prior to first consultation at public health facil- ities, the type of health facilities first visited by patients and longer one way walking time to a nearby health facil- ity (Table 4). Prolonged patient delay was not related with patients' awareness of the cause of PTB, perception of risk of transmitting the disease to family members or the level of fear to reveal their disease to others (Table 5). Table 6 shows the results of the multivariate analysis of risk factors for prolonged patient delay. Prolonged delay was significantly higher among illiterate patients than Page 3 of 10 (page number not for citation purposes)